CareFirst Careers

Financial Analyst

Resp & Qualifications

PURPOSE:  CareFirst has corporate goals to transition from paying fee-for-service to value-based contracts. The primary function of this position is to administer incentive payments in accordance with the value-based contracts entered into by the company. 

This position reports directly to the Manager of Provider Finance.  The incumbent is responsible for the administration of CareFirst policy and provider contracts financial incentive payout and loss collection. The incumbent will be required to understand contracts, measurement criteria, run reports, deal with exclusions/exceptions, make arrangements for payouts that are auditable and ultimately routinized. This position will work closely with Provider Contracting, Accounts Payable, and Actuarial departments.

 

PRINCIPAL ACCOUNTABILITIES:

Under the general supervision of the Manager of Provider Finance the incumbent’s accountabilities may include, but are not limited to, the following:

  • Administer value-based provider contracts including PCMH, ACO, and episode-based models.  Calculate, validate, and pay incentives in accordance with the contracts.  Calculate, validate and collect amounts due according to contracts with shared risk arrangements.  Conduct reporting to confirm earned incentive payment is valid and accurate.

  • Through an understanding of value-based contract methodologies and incentive structures, collaborate with Value Based Payment team and Networks Management team to design, build, implement, and routinize incentive structures.

  • Participate and support internal and external audit processes.

  • Support the monitoring of contract compliance and assist with dispute resolution.

  • Assist in the effort to model economics of contracted providers to determine appropriateness of unit cost and incentive payments.

SUPERVISORY RESPONSIBILITY:

This is an individual contributor role with no supervisory responsibility.

SCOPE DATA:

This position supports the activities and administration of provider finance and incentive payout related to value-based contracts in all CareFirst regions.  This position will also include measuring and delivering notices as appropriate for compliance with value-based contracts.  The incumbent may also work with other BlueCross and/or BlueShield plans from time to time when their Members are accessing care from Providers in CareFirst’s value-based programs. 

QUALIFICATION REQUIREMENTS:

Required Education/Experience/Skills/Abilities:

  • Bachelors degree in business or finance or related field. In lieu of Bachelor’s degree, must have 4 years related experience.

In addition:

  • 1-3 year experience with financial analysis.  

  • Must demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time.  Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.   Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Preferred:

  • Possess a thorough understanding of hospital and health care contracts and reimbursement methodologies, value based contracting methodologies and contract compliance, and fee-for service payment management.

  • Possess a broad understanding of revenue cycle management and claims adjudication.

  • Work experience in the health care industry and/or healthcare operations experience

  • Previous managed care, State and/or Federal health care programs (i.e., Medicaid, Medicare) or health insurance payor industry experience.

  • Experience in administration of Medicare/Medicaid health plans

  • Knowledge of Maryland’s regulated hospital rate setting system

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

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Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

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Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 5/6/2020

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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