JOB SUMMARY

This position plays a key role in driving financial performance, revenue optimization, and operational efficiency. Is responsible for developing data-driven financial models, analyzing key business metrics, and supporting decision-making to enhance profitability, const containment, operational efficiency and streamline business operations. Critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details, abstract up from low-level information to a general understanding, and distinguish user requests from the underlying true needs. This role will improve revenue cycle management, optimize cost structures, support the development, implementation and monitoring of operation Key-Performance-indicators (KPIs), support medical director, stars, clinical liaison, network, contact center, social worker, administrative and executive initiatives by providing actionable insights that directly impact the organization’s financial and operational success in a timely manner. Analyze the situation or problem compared with previous situations to identify a pattern or the root cause.

ESSENTIAL FUNCTIONS

• Business Intelligence and Reporting: Design and implement automated operational KPIs (Key-performance-indicators), operational and financial dashboards using Business Intelligence (BI) tools to enable real-time decision-making for leadership. This includes standardization of reports, frequency and data quality validation assuring the accuracy of the data to be presented and shared.
• Physician and Provider Financial Support: Provide insights on provider medical cost trends and opportunities, financial reconciliation trends, outcomes and recommendations, PCP (Primary Care Physician) Compensation results, forecast and corrective-action-plan (CAPs), flash reports, productivity and operational analysis, and modeling to improve physician compliance, performance, engagement and retention.
• Cross-Functional Collaboration with Triple-S, Guidewell and related subsidiaries. Work closely with finance, operations, IT, and clinical teams to align data insights with business strategy and ensure effective implementation of recommendations. This is to act as liaison between business operations, business segments, PCP Offices and health plan; ensuring accurate information.
• Strategic Initiative Support: Lead and support business transformation projects, ensuring that data-driven recommendations translate into measurable financial and operational improvements and results on a timely-manner. This includes active participation in special programs or large projects of the corporation with many deadlines. Being able to juggle it all is crucial to the job.
• Advanced Financial Modeling and Forecasting: Develop predictive models and scenario analyses to support financial planning and performance at PCP and AMP (Alianza) level, budget management, and strategic decision-making. This includes the evaluation of economic impacts and adequacy of AMP, Administration and related parties’ decisions or strategies.
• Financial and Operational Data Analysis. Conduct deep-dive analysis on revenue cycle performance, claims processing, cost structures, and reimbursement trends to identify opportunities for financial optimization in PCP Practice Management and Administration.
• Technology and Process Automation: Develop, implement or assist in the adoption of AI-driven or optimize financial models, automation tools, and process improvements to enhance operational efficiency and PCP Practice Management. This includes evaluate existing data files, any extractions, different sources of information, files inventory, data processes and validate the accuracy and compliance of the data received and shared by the AMP and PCPs.
• Responsible for ensuring the compliance of regulatory or business reports of the AMP.
• Oral and written presentations on analysis data, business intelligence (BI) tools, dashboard, reports, initiatives to internal or external audience including health plan.

EDUCATION

• Bachelor’s degree in Business Administration, Finance, Public Health, Economics, Data Analytics Statistics or Biostatistics, Demography, Epidemiology. Evaluation of Health Programs or Computer Science preferable, or a related field. 3+ years of experience in financial analysis, healthcare data analytics, or revenue cycle management, preferably in a healthcare setting.
• Relevant certifications (e.g., CHFP, FHFMA, CPA, or Data Science certifications) are preferred. 

LICENSES AND CERTIFICATIONS

COMPETENCIES