Financial Analyst I-Rate Specialist (Full Time, Remote, North Carolina Based)

Overview

The Rate Specialist updates and monitors provider rates for Medicaid, State, and other member services. This position ensures that provider reimbursement rates align with cost-based methods that are financially viable for the organization, support providers financially, and promote quality services for members.

The position is primarily remote. Although routine office attendance is not expected, the successful candidate must come into the office for business and team meetings as needed.

Responsibilities

Maintain Provider Rates

• Maintain and update rates within the Alliance Claims System (ACS) according to the applicable benefit plan and ensure the integrity of rate data in the system.
• Ensure rates align with Medicaid-published rates where applicable.
• Update and track provider- and member-specific enhanced rates by category of service.
• Complete service rate changes and initializations.
• Develop and maintain process flows and procedures covering all aspects of rate setting and maintenance.
• Maintain the published rate schedule.

Review State-Published Materials

• Maintain knowledge of internal and external healthcare fee schedules and analyze comparable provider rates from other payers.
• Participate, as needed, in discussions with the NC Department of Health and Human Services (NC DHHS) regarding rates.
• Regularly review rate materials published by NC DHHS and prepare rate updates according to contractual requirements.

Conduct Financial Analysis

• Conduct financial analyses in response to rate change requests.
• Work closely with Provider Networks and/or Clinical Operations to analyze payment methodologies for In Lieu of Services and Alternative Payment Arrangements.
• Collaborate on new provider rate projects and other strategies to develop financially viable payment structures.
• Work with the EVP/Chief Financial Officer and Finance Manager to develop reimbursement rate offers for providers, including accurate, easy-to-understand analyses of negotiated rates for provider communications.

Provide Customer Support

• Assist with internal and external inquiries to resolve provider reimbursement issues.
• Collaborate with Provider Networks to communicate with the provider community.
• Work closely with the Claims, Provider Networks, Information Technology, and Utilization Management departments.

Improve Reporting and Rate-Update Processes

• Evaluate internal MicroStrategy reports related to provider or member rates for usefulness and accuracy.
• Recommend changes that improve the management of rates and the reporting process.
• Work with Information Technology to develop processes that make rate updates in ACS easier.
• Help develop routine and ad hoc reports for internal review.

Minimum Requirements

Education and Experience

• Associate’s degree in Business Administration, Finance, Public Policy, Hospital Administration, or a related field and at least four (4) years of related experience in financial analysis, with demonstrated capacity to independently draw inferences and communicate findings; or an equivalent combination of education and experience.
• Or
• Bachelor’s degree in Business Administration, Finance, Public Policy, Hospital Administration, or a related field and at least two (2) years of related experience in financial analysis, with demonstrated capacity to independently draw inferences and communicate findings.

Preferred Training and Background

• Background in managed healthcare or insurance operations preferred.

Knowledge, Skills, and Abilities

• Considerable knowledge of standardized accounting practices and principles.
• Knowledge of program components and accounting processes.
• Knowledge of accounting and auditing principles and practices.
• Strong oral and written communication skills.
• Advanced skills with Microsoft products, particularly Excel and Access.
• Ability to apply and explain accounting practices.
• Ability to interpret and analyze accounting data.
• Ability to interpret and apply common to moderately complex Federal and State fiscal regulations.
• Ability to analyze and correct financial problems and accounting errors.
• Ability to prepare interpretive or analytical accounting or financial reports.
• Ability to determine compliance with pertinent guidelines, rules, regulations, and laws.

Compensation

• Salary range: $61,439 - $78,335/Annually
• Exact compensation will be determined based on the candidate's education, experience, external market data and consideration of internal equity.

Location and Work Arrangement

• Primarily remote.
• Attendance at the office is required for business and team meetings as needed.