General Summary:

To assist the Revenue Management and Risk Adjustment department (RMRA) in ensuring the Financial Reporting and Analysis responsibilities for the oversight of the Revenue Management and/or Risk Adjustment programs for all government funded product lines. Under direction of Department Manager:

Principal Duties and Responsibilities:
+ Coordination of weekly and ad hoc data submissions, monitoring data for accurate tracking and reporting of medical, drug claim data and membership data to CMS EDPS and Edge Server. Produce, distribute, monthly, quarterly, and annual key performance indicators (KPI’s) and error/rejection detail for all report submissions and external vendor support system data correction.
+ Premium reconciliation reports for monthly financial close; file payment issues with CMS and monitor response; monitor MMR, MOR, MAO-002, and MAO-004 loads; estimate risk adjustment premium impact for final reconciliation with CMS; allocatio...