Cost and Utilization Analyst; PCN

Cost And Utilization Analyst

The Cost and Utilization Analyst (CUA) is responsible for analyzing and reporting on service delivery and billing activity across multiple provider networks. Analysts' work informs budget preparation, contract compliance, rate setting and provider relations. The CUA partners with internal program and fiscal and external provider stakeholders to assess and properly classify and quantify service delivery and financial results tied to people served.

Essential Functions

• Collect, analyze, and interpret data and statistics tied to cost and utilization trends in services using quantitative and qualitative methods to monitor budget and reporting compliance.
• Assists with preparation of Encounter, Medicaid Loss Ratio and Financial Status Reports to Michigan Department of Health and Human Services (MDHHS) through the year
• Serve as primary financial liaison regarding financial issues and coordinate the financial activities policies, procedures, and directives between the contract providers and OCHN
• Represent OCHN on financial work groups and periodic meetings for their respective provider network(s)
• Act as a liaison between the provider network and MDHHS to communicate feedback regarding changes to funding, procedure codes, and reporting requirements
• Prepare and present complex and detailed statistical analyses and graphical representations of data findings for inclusion in internal and external reports
• Provide statistics and established benchmarks regarding cost and utilization statistics.
• Understand fund source allocation for revenue and expense reporting and compile, analyze and report on operational information including trends, staffing/resource allocation, and budgeting
• Other duties as assigned

Job Requirements and Qualifications

Education:

Bachelor's degree in Business Administration, Finance, Accounting, or Related discipline.

Training Requirements (licenses, programs, or certificates):

N/A

Experience Requirements:

Experience in accounting, finance, or related field.

Experience with both preparing and leading data analytics projects required.

Understanding of generally accepted accounting principles, including accrual based accounting and standard cost allocation.

Minimum 3-5 years of experience with both preparing and leading data analytics projects required.

Preferred Experience:

Knowledge of Medicaid rules and regulations and financial experience in the field of healthcare.

Job Specific Competencies/

Skills:

Highly developed computer skills.

Highly proficient Excel spreadsheet skills

Excellent communication skills including written, verbal, and presentations

Highly effective interpersonal skills in working with Provider Networks.

Ability to prepare and analyze complex budgets.

Ability to review and analyze cost allocation.

Ability to work with and analyze financial information of a complex nature.

Oakland Community Health Network's

Core Competencies:

Interacting with others in a way that gives them confidence in one's intentions and those of the organization; demonstrating loyalty to the organization and its mission and values; maintaining social, ethical, and organizational norms; firmly adhering to codes of conduct and ethical principles. (Integrity/Building Trust)
Making customers and their needs a primary focus of one's actions; developing and sustaining productive customer relationships, recognizing that the ultimate customer is the person served. (Customer Focus)
Actively identifying new areas for learning; regularly creating and taking advantage of learning opportunities; using newly gained knowledge and skill on the job and learning through their application. (Continuous Learning)
Setting high standards of performance for self and others; assuming responsibility and accountability for successfully completing assignments or tasks; self-imposing standards of excellence in addition to consciously adopting organizational standards of excellence. (Work Standards)
Clearly conveying information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message. (Communication)

Additional Information

Must have available…