Finance Program Manager (Performance Analytics)

📋 Description

• • Lead financial performance analysis for Population Health programs, focusing on ACO, TIN, and NPI-level metrics across Medicare Shared Savings Program (MSSP) and Medicare Advantage (MA) arrangements.
• • Analyze claims, eligibility, and contractual data from CMS and payers to identify financial trends, risks, and opportunities in value-based care models.
• • Translate actuarial and management guidance into accurate financial forecasts and scenario models that support operational decision-making across Health Select Services entities.
• • Develop and maintain trend analysis reports monitoring key performance indicators (KPIs) against internal benchmarks and external standards to guide performance improvement strategies.
• • Set and track financial targets by TIN, provider group, and market, collaborating with ACO/CIN network teams to align performance with strategic goals.
• • Conduct routine audits and analytics to validate attribution accuracy, quality performance, and financial reconciliations for value-based programs.
• • Ensure compliance with HIPAA regulations, data governance standards, and protection of protected health information (PHI) in all analytical workflows.
• • Utilize PH tools, claims databases, and reporting systems to deliver clinical, financial, utilization, and claims analytics to leadership and stakeholders.
• • Perform hands-on analysis of workflows and documentation to improve data integrity and process efficiency across Population Health finance operations.
• • Provide ad hoc financial analyses to support vendor performance reviews, strategic initiatives, and financial planning activities.
• • Monitor internal controls and recommend improvements in coordination with BSMH Internal Audit, third-party vendors, and cross-functional teams.
• • Work closely with external actuarial consultants, internal finance, IT/analytics teams, clinical leaders, and market leaders to align financial insights with care delivery objectives.
• • Apply advanced Excel skills including complex formulas, pivot tables, and lookups to manipulate and analyze large financial datasets.
• • Build and maintain data visualizations using Tableau or equivalent tools to communicate financial performance and insights to non-technical stakeholders.
• • Navigate and query relational databases to extract, validate, and optimize healthcare data for reporting and forecasting purposes.
• • Conduct statistical analysis to estimate probabilities, benchmarks, and projected costs for patient populations and risk-based contracts.
• • Support the evaluation of full-risk arrangements including bundled payments, shared savings, and capitated models to assess financial viability and compliance.
• • Maintain expertise in Medicare CCLFs, payer claims files, and BDCA early insights indicators to inform financial modeling and program performance.
• • Collaborate with IT support to leverage Epic data systems for enhanced analytics, when applicable.
• • Apply knowledge of Milliman Medinsight or similar claims-based data warehouses to conduct in-depth financial and utilization analyses.
• • Translate complex data findings into clear, actionable recommendations for leadership and operational teams.
• • Demonstrate strong attention to detail, accuracy, and accountability in all data handling and reporting activities.
• • Adapt to evolving priorities and stakeholder needs while maintaining strict adherence to financial controls and compliance standards.
• • Engage effectively with cross-functional teams to build relationships, drive collaboration, and ensure alignment on financial performance goals.