This job has now expired
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota???s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We???re an organization that???s going places. Be part of a team that cares about you, be part of UCare.
The Revenue Manager position will be responsible for the organizational revenue reporting and projections. Oversee the reporting and data sharing for the contracted prospective and retrospective HCC vendors for estimating and modeling anticipated CMS payment updates. Work with the Accounting Dept leadership to set revenue accruals, oversee development of the CMS benchmarks and risk score projections for the annual CMS Part C and D bids. Maintain benchmark reporting of overall revenue results and projections based on key indicators from enrollment, encounters, and risk adjustment activities. Lead the strategy for the reporting of DHS quarterly risk factor updates and the risk adjustment activities supporting the health insurance exchange. Specific duties and responsibilities include:
- Lead the organizational revenue reporting and analysis including interim reporting for management, modeling of regulatory payment changes, and projection development.
- Oversee the analytics and monitoring of member risk scores by line of business, product, region, living status, care system, etc. Identify opportunities and develop strategies for revenue enhancement.
- Lead the relationships with UCare's prospective assessment and retrospective/clinical assessment vendor to ensure optimization of CMS payments.
- Lead the projections and analytics process for the annual CMS Part C and D risk scores, Part C benchmarks and payment estimates, and estimated projection factors based on CMS instructions and consulting actuarial guidance.
- Maintain a strong understanding of UCare revenue sources and payment processes. Monitor and analyze changes due to CMS guidance, DHS guidance, Health Insurance Exchange, or other modifications to payment models and payment processes impacting UCare.
- Oversee the annual development of revenue and risk score assumptions for the CMS bidding project and the UCare budget process. Maintain up to date reporting of actual results to projected, identify and research variances from projections.
- Collaborate with the Accounting department leadership to accurately predict revenue adjustments for the CMS payment updates and the annual health care exchange reconciliation process.
- Maintain a strong understanding of UCare product lines, encounters and reporting requirements, enrollment, and HMO Industry.
- Develop a strong understanding of risk adjustment payment methodologies and DHS payment & risk adjustment methodologies including encounter data requirements and working collaboratively with internal areas including IT.
- Represent Health Care Economics on UCare cross-departmental projects and workgroups as an active contributor and supporting resource.
- Maintain appropriate documentation for departmental processes.
- Ad Hoc analysis and other department support as needed.
B.A./B.S. in Finance or Economics related field. Two or more years of supervisory experience. Strong financial analytics background and technical skills. Minimum of 6 years of Finance Analysis experience, in healthcare preferred. Knowledge using SQL, SAS, or other statistical software is preferred.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You???ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis???just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.