Medicaid Financial Analyst

Overview

Presbyterian is seeking a Medicaid Financial Analyst

• Serve as key individual contributor to review and analyze directives from the New Mexico Health Care Authority (HCA) for PHP’s Medicaid program to ensure financial compliance, review the adequacy of funding for each directive, support provider rate implementations, and perform provider rate reconciliations. This role will partner with multiple business areas within the health plan to ensure directive compliance and optimal financial performance.
• Lead sessions for strategic and operational planning and implement outcome of plans and directives
• This role will be involved in meetings where decisions are made and presentations are required for senior leadership, the Board of Directors and/or other organizations within PHP.
• Problem solver for urgent financial issues impacting the organization.

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Benefits: PRN/PT (working less than a .45 FTE) employee benefits available for this position such as medical, gym memberships and an employee wellness program.

Ideal Candidate:

• CPA License and/or Masters degree.
• Experience dealing with highly confidential information.
• Interfaces with all levels of the organization including the CEO.
• Collaborate and achieve actionable results through others.
• Builds strong, sustainable relationships.
• Combination of technical, financial, and business knowledge and experience.

Qualifications

• Bachelors degree in finance, accounting.
• Four years of health care finance experience or equivalent work experience.
• Intermediate to expert MS Office skills with focus on PowerPoint and Excel
• Business acumen to handle both complex situations and multiple responsibilities simultaneously

Responsibilities

• Review directives from New Mexico Health Care Authority (HCA) to size financial impact
• Partner with Medical Economics to review adequate funding for each directive
• Support provider rate implementations by ensuring applicable provider or revenue/CPT code rates are implemented accurately as outlined in directives
• Audit final implemented rates to ensure accurate payment on claims to providers and prevent over/under payment.
• Reconcile Provider Rates in PHP’s Claim System to ensure timely updates to monthly provided Medicaid Floor Rates from HCA and provider agreements
• Respond to HCA’s directive drafts regarding any issues or recommended draft corrections
• Project management: Lead a variety of projects related to organizational undertakings related to financial objectives. Organize, schedule, plan and manage senior-level team activities. Create, monitor and manage all timelines. Create presentations for senior level meetings and briefings. Develop agendas, content and manage meetings and internal communication for various daily, weekly, monthly, quarterly or annual meetings. Manage evolving requirements and course-correct as needed to achieve objectives. Gather input from members at all levels of the organization to generate and deliver presentations accurately and in a timely fashion. Utilize influence skills to achieve project objectives and support from senior leaders. Act on behalf of the Finance Director in a decision-making capacity on assigned projects as required. May act in place of Finance Managers when positions are vacant and during the hiring process
• Strategic Planning: Provide and coordinate financial analysis for strategic initiatives identified by the Finance Director that are outside typical operations.
• Prepare reports and craft consistent messaging for dissemination of any financial information. Provide backup support for the Finance Director or Managers as needed and/or attend meetings on their behalf.
• Represent the Finance Director or Manager as required regarding business expansion and growth activities or strategy sessions.
• Financial Support: Provide financial management consulting and analysis for the finance department and other departmental organizations throughout the company as