Job details
Job type contract
Full job description
Description:
About paradigm
Paradigm is an accountable care management organization focused on improving the lives of people with complex and catastrophic injuries and diagnosesWe have been a pioneer in value-based care since 1991, offering deep clinical expertise, high-value specialty networks, behavioral health support, payment integrity solutions, and robust data analytics to generate the very best outcomes for patients, payers, and providers.
Paradigm is headquartered in walnut creek, california, with offices across the u.sFor more information, please visit www.paradigmcorp.com.
The risk analyst is responsible to assist with the accuracy of injured workers’ risk based contract budget forecastsThis will be accomplished by working in collaboration with multiple teams including clinical services, clinical operations (provider contracting & bill review), claims services and senior management.
Requirements:
Detailed review of paid claim reports and clinical progress reports for key significant financial events and/or clinical confinementsUpdate each forecast or alert the director of clinical with findings/changes to include: true-up of forecast to paid claims, update and confirmation of known/future service dates, adjustment for future services based on changes in the clinical course of treatment.
Collaborate with the clinical team including the director of clinical services to determine the current and future medical/financial course and its impact to the financial forecast.
Work with the contracting department to follow-up on outstanding confinement bills or high cost services or supplies.
Work with the bill review department to include; outstanding unpaid bills in-house, claims alerts, and variations in paid claims to negotiated or quoted estimate and general paid claims questions or concerns.
Manage key financial alerts and/or drivers that would impact the monthly financial close as it relates to the accuracy of the overall forecast, to include: insufficient funds review, low remaining overall costs and the associated contract length and/or management time remaining.
Monthly and quarterly quality assurance of all forecasts through the development of analytics that will help to highlight any potential issues or concerns.
Work with the auditors or assist in providing information, at the end of the year to research any questions surrounding financial incurred but not reported (ibnr) and the accuracy of risk based forecasts.
Work with vp of risk, analytics and pricing and senior risk analyst to determine trends and identify improvements that can be made to enhance the accuracy and ease of budget development and/or forecasting.
Additional analytics or projects as required related to the overall financial performance of risk based contracts.
Responsible for complying with paradigm it security requirement and policies.
Responsible for safeguarding paradigm or paradigm related it passwords.
Responsible for notifying paradigm of any it security incidents per policy 16.0 information security incident management or future developed and adopted policy in accordance.
Qualifications:
Bachelor’s degree or equivalent experience.
5 to 10 years data analytics experience.
Experience with data analytics software or tools required.
Exceptional computer skills including microsoft office and web-based applications advanced skills in microsoft excel and access or like databased program.
Excellent organizational skills and attention to detail.
Work collaboratively with all team members.
Ensure quality-based work consistent with customer wishes and company standards.
Excellent time management.
Self-motivated and able to work with little supervision.
Ability to establish interpersonal relationships in a virtual work environment.
Ability to collaborate and work as a member of a team.
Excellent problem-solving ability.
Clear, concise and professional verbal and written communication.
Pm19
