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Revenue Analyst

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POST DATE 9/7/2016
END DATE 10/28/2016

Tufts Health Plan Watertown, MA

Watertown, MA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


Under the general supervision of the manager, this individual must be able to independently perform the tasks associated with confirming appropriate payments from the Federal government. This includes reconciling CMS files, performing root cause analysis to resolve discrepancies, and generate revenue reports based on department protocols. Additionally, there are cross-functional tasks related to the SCO product offerings.

The Revenue Analyst will participate in project initiatives sharing subject matter expertise to achieve business goals. Ensure compliance with all CMS regulations and internal department processes while fully supporting the expansion of product offerings and process changes as a result of such. Also, this individual is responsible for building and maintaining positive relationships with all stakeholders.

This individual must demonstrate personal resiliency in times of changing direction; and be able to plan, organize, and prioritize work to ensure completion by deadlines. He/she must be able to proactively escalate issues, identify areas of process improvement, document suggested changes, and consistently support collaboration efforts within the Membership Accounting Team, and across all THPMP departments.

* Revenue analysis, trending, and reporting
* Run database queries and summarize data
* Monthly, quarterly, annual financial reporting
* Monthly reconciliation of payments
* Refine reconciliation and analysis for the following: Medicaid and Medicare members
* Analyze reports (from applications & database), raise questions, research
* Review results with manager to ensure accuracy
* Ensure accuracy of data submission to CMS and CareMark
* Review/research data rejects
* Analyze trends; provide reporting
* Refine reconciliation and analysis, as needed
* Support root-cause analysis; propose process improvements
* Collaborate on implementation of new process reporting
* Provide input for routine or non-critical issue resolution
* Contribute to process enhancement opportunities; make proposals and recommendations
* Represent department in small to medium projects and workgroups
* Ad-hoc projects, as necessary (Such as SCO product offerings)
* Conduct in depth quality checking; identify QC training opportunities and trends
* Monitor/measure productivity standards for quality and quantity; report to manager
* Create/format reports (worksheets, graphs, business documents)
* Contribute to enhancement opportunities for databases and applications
* Collaborate on receipt of CMS reports

QUALIFICATIONS: (Minimum education & experience required)
* Bachelor's degree required (Business/Accounting/Finance major)
* 3-5 years related business experience (Medicare/Medicaid experience preferred).

SKILL REQUIREMENTS: (Include interpersonal skills)
* Intermediate level financial skills (analysis, reporting and trending).
* Significant MS Office skills, with focus on Excel and Access at an advanced level.
* Effective communication skills (verbal and written skills). Ability to independently handle escalated issues.
* Ability to perform thorough research and analysis, documenting results, and communicating to various audiences.
* Quick learner.
* Demonstrated attention to detail; achieving a high degree of accuracy.
* Strong time management skills in order to effectively multi-task while meeting established deadlines.
* Proficient in usage of Microsoft Office Suite, E-mail, etc.
* Ability to become proficient in navigating through internal & external applications.

Interpersonal skills (include personal interaction):
* Demonstrate flexibility, commitment, and resiliency in times of business and organizational change.
* Demonstrate professional demeanor at all times
* Support collaboration across Membership Operations and other departments and work cooperatively as a team member.
* Provide/accept constructive criticism for improvement, including peer and manager feedback for performance management. Coach others to do so, as well.

WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS: (include special requirements, e.g., lifting, travel, overtime)
* The Revenue Analyst position is exempt and may require occasional evening and/or weekend hours as dictated by the needs of the business.
* The work environment is an open-office cube arrangement, enabling collaboration.
* The department is a fast-paced office environment handling multiple demands.
* Requires that the individual be organized while being readily adaptable to changes in work priorities.
* The individual must be able to work independently and in a team environment.

CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled


Founded in 1979 as a non-profit health maintenance organization (HMO), Tufts Health Plan is one the country's largest HMO offering a full array of healthcare coverage options to individual consumers and employer groups. Tufts Health Plan has received high marks for its quality from a variety of third parties including U.S News & World Report and Newsweek.