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Role Description

This role will be working with a cross-functional team in a centralized firm role, supporting multiple accounts, and is responsible for working closely across firm and client leadership to meet the finance, analytics, and population health needs of our clients.

• Generate quantitative analyses and financial models using available data and industry knowledge-based assumptions to provide forecasts of future Medical Loss Ratio, Out-of-Network utilization, RAF scores, premium revenue, membership growth, etc.
• Subject matter expert on MSSP and ACO Lead to support financial modeling and strategic decisions for ACO clients.
• Build or configure financial models, financial statements, budgets, and analytical reports based on client and team specifications.
• Support analytics and finance functions for CHS IPA/RKK and ACO such as required financial filings with California DMHC and CMS.
• Collaborate with and help develop a team of consultants to execute client engagements related to healthcare finance and ensure that deliverables are prioritized appropriately, complete, and accurate.
• Deliver effective decision-making support by analyzing complex financial information, forecasting business trends, industry and economic conditions, and presenting implications and proposed solutions to clients and company leadership.
• Provide support to client’s payer and provider contracting strategies and support in contract negotiations.
• Manage validation and documentation processes for team’s work outputs to ensure reliability of models, replicable results, and efficiency of the production process.
• Lead the implementation of use cases and models to project and test key client needs with respect to population health and financial modeling.
• Collaborate with in-house analytics and financial modeling teams to inform further development of existing product tools and/or offerings.
• Manage client deliverable from scope development to output generation, with responsibility of informing the firm’s leadership of issues affecting timeline and outputs.

Qualifications

• Bachelor’s degree with a quantitative, business finance or technical focus required, Master of Business Administration preferred.
• Minimum 10 years of professional experience performing financial planning, analytics, and modeling at a health plan, health system/provider group in a client services capacity.
• Experience with CA risk models and the CA risk environment.
• Minimum 5 years of health plan finance, FP&A, or analytics experience.
• Actuarial experience a plus.
• Experience with medical and pharmaceutical claims, member eligibility and other payor reporting items.
• Awareness of population health analytics and health care data (e.g., CPT/HCPS, ICD9/ICD10, revenue codes, DRGs, risk scores), Medicare and Medicaid value-based care arrangements and dual-risk and capitation models preferred.
• Proficiency in SQL, analytical tools, and data visualization and business intelligence platforms (e.g., Tableau, PowerBI).
• Ability to create advanced analytical models and visualizations.
• Familiarity with SAS/STAT software is a plus.
• Knowledge of predictive modeling and ability to communicate its complexity to end users/clients.
• Understanding of Medicare, Medicaid and/or Commercial health plan and payment methodologies (e.g., APC, RVU, PPS).
• Experience with Medicare Advantage Bid Development preferred.
• An ability to effectively manage and communicate with technical contributors and business colleagues to translate business requirements to technical specifications.
• Ability to facilitate strategic discussions and presentations around areas of expertise with diverse stakeholders (executives, physicians, and analysts) regarding data management, population health analytics and infrastructure.
• Flexibility to work evenings and weekends as needed.
• An ability to travel up to 25% at times consistent with firm policies and client preferences.

Benefits

• Comprehensive, affordable insurance plans for team members and their families.
• Yearly stipend for wellness-related activities.
• Paid parental leave program.

Company Description

COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers.

To Apply

To apply for this position or for more information about COPE Health Solutions, visit us at COPE Health Solutions Careers .