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Actuarial Analyst

Company: Alliance Healthcare Services
Location: Irvine
Posted on: December 4, 2019

Job Description:

About UsAt Alliance Radiology, our team members focus on transforming the patient experience and delivering exceptional quality care. Alliance Radiology has rapidly grown over the past 30 years by providing radiology service line solutions, outpatient center management services, and mobile radiology solutions (Per Diem, PT, and FT MRI, PET/CT, CT).Job ResponsibilitiesThe -Payor Intelligence Actuary -is responsible for conducting analyses to estimate financial outcomes. This role will work in conjunction with the Sales and Marketing teams and Regional Operations teams to develop financial analyses specific to each retail and wholesale location, including payor contracted rates, Medicare/Medicaid rates, worker's compensation rates, total and variable cost per scan, and the revenue impact of new and changing rate - information used in the development of a site level managed care strategy. The Acturial Analyst will also conduct payor market research for potential new payor contracts and for the development of new fixed site locations. Additional responsibilities include market research for data related to the payor-market dynamics and, developing internal database structures, using publically available data for reporting and analysis purposes.Specific duties include, but are not limited to:Supports fixed site development and acquisitions:A. Participate in the due diligence of acquisitions by evaluating and providing analysis on the existing payor contracted rates inherited from the acquired company. Determine the revenue flow from each acquired payor contract and make recommendations to maintain or terminate the contract.B. Develops statewide payor-competitive analysis to determine the viability of pursuing fixed site development in that state, including county scope data of comparable providers. Project estimated volume and expected revenues of potential acquisitions.C. Develop competitive pricing and cost information for each provider and payor competitor in the market at the CPT code level.D. Create standard fee schedules for each market within the state for different levels of service.E. Participate in leadership project calls for implementation and integration of new fixed site locations. Present analysis, recommendations and concerns related to different possible approaches with individual payors in the market. -Prepare analytical reports and presentations to support the setting of market level managed care strategies and pricing methodologies. Research and develop market analysis for unfamiliar territories. Maintain knowledge of public databases in each state and the available relevant data. Develop and utilize analytics around competitive reimbursement to set managed care strategy and rates for a single Payor or group of Payors within a market.Participate with project teams to implement future ACR registries for company-wide activities and new acquired sites, including MACRA/MIPS, Dose Index Registry (DIR), Lung Cancer Screening (LCSR), National Mammography Data Base, and General Radiology Improvement Data (GRID).Work in conjunction with the Sales and Marketing and Regional Operations teams to respond to client data and market needs, or requests. Participate in work groups to develop new mobile retail and wholesale locations. Research and communicate changes in payor policy that may impact physicians, clients, patients or on the locations revenue. Participate in client and physician calls when requested to provide specific expertise by explaining and presenting complex actuarial concepts to nontechnical audiences.Position RequirementsBachelor's degree in Mathematics, Statistics or Healthcare Administration; or equivalent experience required. -Associate, Society of Actuaries (ASA) Designation required. -4-7 years of progressively responsible actuarial experience, including healthcare actuarial experience with payor, provider, Medicare and Medicaid financial components (budget, charge structure, reimbursement formulas, healthcare finance) required.Previous experience with Radiology, Oncology, Medicare, Medicaid and Workers' Compensation claims and rate data preferred.Previous experience with regulatory reporting for Independent Diagnostic Testing Facilities (IDTF) and Professional Groups preferred.Knowledge of billing and reporting software such as Intergy, Medinformatix and Sharepoint preferred.Knowledge of advanced statistical techniques and concepts. Excellent analytic, math and statistical skills including variable and full cost analysis, risk modeling, and breakeven analysis. Ability to identify errors in the data and the knowledge of how to correct the errors.Excellent knowledge and previous use of industry databases such as the Advisory Board and Definitive. Previous experience with several state databases that capture commercial, Medicare and Medicaid charge, allowed and paid rates.Superior experience and proficiency with Excel including the use of pivot tables, slicers, formula and calculation set up. Ability to troubleshoot and correct incorrect formula calculations.Programming and database query experience with SAS, SQL, Crystal Reports or similar tools.Excellent written and verbal communication skills.Experience researching Federal, State and other publically available data sources for information pertinent to the market being evaluated.Must be self-motivated, reliable and capable of working independently as well as part of a team.Excellent problem solving skills with the ability to draw valid conclusions from the data and analysis.Extensive knowledge of the Microsoft office suite of products.Must be results oriented and capable of managing work to satisfy all managed care department and individual Key Performance Indicators (KPI's).Job may require 10% of local travel.

Keywords: Alliance Healthcare Services, Irvine , Actuarial Analyst, Accounting, Auditing , Irvine, California

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