Senior Financial Analyst, Medicare Financial Economics

Salary Range: $89,000.00/yr - $108,000.00/yr

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.  

Who Are We? ✨ 

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. 

Why Join Us? 🏆

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. 

Job Summary

The Senior Financial Analyst – Medicare Finance Operations (MFO) is responsible for designing, reporting, and analyzing income statements by medical group, assuring accurate payment of capitation, and risk pool reporting and periodic payments. Also supports the analysis of membership, revenue and healthcare costs including support for budgeting/forecasting, CMS bid process, medical expense analysis, contracting support, and Part C and Part D reporting.

Functions & Job Responsibilities

• Assist in the development of Provider Management Report (PMR) and financial models to track profitability by medical group, by line of business, by product line, by Plan Benefit Package (PBP), by region, by risk type, and by member type (dual-eligible vs. non-dual eligible).
• Analyze the financial performance of contracted medical groups. Research and provide explanations for the factors (e.g. utilization, risk scores, rates, etc.) that drive financial performance.
• With thorough understanding of global, professional, and shared risk capitation terms, use Clever Cap to calculate monthly provider group capitation.  Calculate related capitation deducts and track the recovery process. 
• Provide monthly reporting for membership, risk pool performance and Rx rebate estimation to the accounting team for recording during the month end close process.
• Support Network Management contracting initiatives with timely and comprehensive medical group, hospital, and ancillary contract analysis.
• Use available data mining tools to retrieve information from various sources. Organize the information collected into a readable format or report. Present the information in a concise and understandable manner to colleagues and management.
• Provide financial analysis support for contract negotiation, corporate budgeting and forecasting process.
• Provide data to support the annual CMS bid process. Specifically, assist in the development of Medicare Part A/B/D bids and reconciliation to the financial statements.
• Prepare reconciliations and supporting schedules for various financial audits.
• Maintain MMR database with thorough working knowledge of MMR layout and meaning of each MMR field. Reconcile monthly CMS payments.
• Prepare and submit reports (MLR, DIR, PDE, P2P, etc.) to CMS for various attestations. 
• Partner with IT to automate processes and reports for efficiency.
• Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Contribute to team effort by accomplishing related results as needed.

Other duties as assigned.

#LI-Hybrid
 

Qualifications

Education and Experience: