Manager, Medicare Advantage Financial Analysis, Remote



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Accounting & Finance
Atlanta, GA, USA
Posted on Wednesday, January 3, 2024
We are currently recruiting a Manager of Medicare Advantage (MA) Financial Analysis to support success across Aledade’s MA value-based contracts. Under the direction of the Sr Director of Financial Performance, this Manager will focus on complex issues involving Medicare cost reporting, revenue, and attribution. This Manager will perform due-diligence on financial and attribution reports for Aledade’s MA value-based contracts. This will include technical analysis of claims, non-claims based expenses, attribution, risk adjustment payments, and other quantitative analysis on health care cost and utilization. The Manager must be highly detail-oriented, service-oriented, possess strong verbal and written communication skills, and be highly fluent in data analysis.
We are flexible with respect to geographic location, and the ideal candidate will be comfortable working remotely within the US or at one of our office locations.

Primary Duties

  • Review revenue and expense data for MA value-based contracts. Establish processes to routinely and systematically review data for discrepancies, duplications, and errors in payer reports. Work collaboratively with MA payers to successfully resolve issues. Partner with internal teams (ie, finance, accounting, actuary, strategic payer partnerships) to support review and due diligence of financial reconciliations.
  • Analyze utilization and cost of MA clinical programs and non-claims payments (eg, capitation, third party vendors). Work collaboratively with MA payer partners to obtain necessary data (eg, capitation reports) to assess utilization of existing and future programs. Work with internal stakeholders to assess the ROI of programs and support negotiations with payers.
  • Audit attribution on an ongoing basis and work collaboratively with payers to resolve errors and disputes. Establish policies and procedures with internal and external stakeholders for attribution disputes and contestations.
  • Support the audit and technical analysis of other lines of business (commercial, medicaid) as needed

Minimum Qualifications

  • Bachelor’s degree in related field or equivalent work experience required
  • Excellent quantitative analysis skills with 5+ years experience in healthcare analytics (payer / provider / vendor)
  • Advanced ability with Excel / Google sheets and data manipulation skills (SQL/SAS/R)
  • Advanced knowledge of Medicare Advantage revenue and claims payment/processing
  • Familiarity with CMS risk adjustment methodologies and payment

Preferred KSA's

  • Master’s in a relevant field is preferred (data science, business, finance, economics, health administration, actuarial science, etc)
  • 5+ years experience in Medicare Advantage economics (contractings, bidding, P&L management, policy)
  • Ability to create and translate complex analysis to executive presentations for senior leadership
  • Familiarity with attribution methodologies in value-based care
  • Experience with value based care
  • Actuarial skills

Physical Requirements

  • Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
Who We Are:
Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of payers, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives, and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners Robust time off plan 21 days of PTO in your first year 2 Paid Volunteer Days & 11 paid holidays
12 weeks paid Parental Leave for all new parents
6 weeks paid sabbatical after 6 years of service
Educational Assistant Program & Clinical Employee Reimbursement Program
401(K) with up to 4% match
Stock options
And much more!
At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop, and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance, and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
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