Peak Health

Accountant

• Performs a wide range of professional accounting functions in accordance with Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (SAP) to support the month-end financial statement process of Peak Health entities.
• Completes documentation and schedules during month-end, budget preparation, and external audit.
• Prepare quarterly and annual statutory reporting, filings, and compliance tasks.
• Provides financial guidance to department managers to help control costs and provide organization-wide efficiencies.

Senior Statutory Accountant

Manager

• Designs, builds and maintains operational processes, policies and procedures to support Claims processing
• Partners with IT and other leaders to develop business requirements to support core administration system deployment
• Recruits, trains and develops a highly engaged team of claims processors
• Claims inventory management and load balancing to meet contractual and organizational objectives
• Anticipates future demands of initiatives related to people, process and technology and works with leadership to design and implement solutions to these needs
• Collaborates with IT, Enrollment, Medical Management, Member & Provider Services and Finance to identify and implement processes to drive continuous improvement
• Continually assesses activities and processes to ensure efficiency and added value

Manager, Commercial Claims

Business Intelligence Developer

• Assists with the development, scaling, improvement, and maintenance of data models, dashboards, and analytical solutions supporting Peak Health operations
• Leverages complex analytical tools to provide business and technical expertise to create data driven solutions
• Partners with health plan leadership, product, operations, medical management, and provider contracting teams to understand & anticipate reporting requirements, priorities, and key performance indicators
• Provides thought leadership to key business stakeholders, translating data into actionable insights using appropriate analytical solutions
• Produces repeatable and ad-hoc reports for key business stakeholders to measure and interpret business trends
• Participates in a variety of assigned operations initiatives to ensure success in meeting business goals and objectives
• Provides mentoring and guidance to Business Intelligence Engineers on processes and practices related to repeatable and ad-hoc reports, defining business cases, and supporting key business stakeholders
• Collects report requirements – interview and research business stakeholder needs; draft, edit and validate requirement documentation
• Provides input on project plans, scope of work, status, and project summary reports
• Provides input on strategies and tactics regarding platforms, tools, and technical staffing to meet customer needs
• Communicates results of analysis effectively and regularly to business stakeholders

Senior Business Intelligence Engineer

• Performs a wide range of professional accounting functions in accordance with Generally Accepted Accounting Principles (GAAP) and Statutory Accounting Principles (SAP).
• Supports the month-end financial statement process of Peak Health entities.
• Completes documentation and schedules during month-end, budget preparation, and external audit.
• Provides financial guidance to department managers to help control costs and provide organization-wide efficiencies.

Senior Insurance Accountant

• Participate in activities related to care management program build, implementation, oversight, and delegation.
• Perform utilization management reviews as needed according to accepted and established criteria, as well as other clinical guidelines and policies.
• Manage and triage member self-referrals to care management programs.
• Assist members in understanding their available medical benefits and connecting them with in-network providers and community resources.
• Identify barriers preventing the member from meeting maximum quality of life.
• Review and Evaluate Health Risk Assessment (HRA) data to help drive development of programs and services geared toward member needs.
• Review and Evaluate member outcomes data and work with other team members on performance improvement opportunities.
• Utilizing NCQA standards in auditing processes of member records as part of care management oversight processes.
• Investigating potential quality of care issues that may affect the quality or safety of the health of members.
• May review medical records and other documentation to ensure quality care.
• Assist in reviewing and updating activities and resources to address member needs.
• Participate in case management and quality committees.
• Assist in reviewing and updating policies and procedures to align with delegated processes.
• Assist in quarterly reporting of delegated case management processes to meet accreditation standards.
• Assist in submission of required documents/policies during application process to accrediting body.

Care Manager, RN

Accounts Payable

• Compiles and processes accounts payable, maintains day to day payment cycle, and provides efficient customer service.
• Verify approval on all payment requests.
• Process payments to contracted providers for claims submitted to and processed by the Claims Operations department.
• Resolves problems associated with payables transactions.
• Reconciles processed work by verifying entries and comparing system reports to balances.
• Provides accurate and effective document preparation and records management relative to the Accounts Payable function in accordance with records retention policies and procedures, and any federal regulations (if applicable).

Senior Statutory Accountant

Manager, Commercial Claims

Senior Business Intelligence Engineer

Senior Insurance Accountant

Care Manager, RN

Accounts Payable Representative