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Financial Analysis
- Monthly/Quarterly MCO financial settlement review
- Funding/Claims analysis
- HCC funding review and reconciliation
- Medicare Risk Adjustment (MRA) analysis to optimize funding based on patient population, severity diagnosis and acuity level
- IBNR analysis to ensure consistency and uniformity in MCO chosen methodology
- Assigned membership accretion and deletion review to scrutinize for unreconciled or omitted member funding
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