David Balencia Email & Phone Number

Tacoma, Wa, Us

• Manage finance functions within the Population Health team at MultiCare Connected Care (MCC), an Accountable Care Organization (ACO) and a comprehensive Clinically Integrated Network (CIN), supporting financial reporting for our value-based arrangements.• Financial reporting for Value Based Arrangements (VBA) Connected Business Unit (CBU) to include monthly review and accruals, actual vs. budget variance analysis and writing up the monthly narrative.• Create monthly forecasts and rolling forecasts for the IBU that supports the VBA, Population Health, Care Management, Clinical Value, Provider Network, and Employee Health Plan. • VBA monthly revenue updates for Commercial, Medicaid, MSSP, and Medicare Advantage risk-based contracts and dashboard reporting to include membership lives, estimated projections for value-based revenue, estimated opportunities, downside/upside risk share, and low and high range opportunities.• Reconcile value-based payments (VBP) for accountable care payments (PMPM), incentive quality bonus payments and risk share payments against settlement timelines aligned with VBA contracts. • Employee health plan (EHP) monthly financial analysis by trending PMPMs for internal and external claims, HCG (Health Cost Guidelines), CCHG (Chronic Conditions Hierarchical Grouper), COC (Categories of Care), high-cost claimants over $100k, risk scores, and membership by plan. • Capital planning and strategic initiative long range plans• FTE staffing models, position control creation and maintenance, submission of RTHs (Request to Hire), variance analysis, monthly reporting, forecasting and annual budget. • Annual budget for VBA and Population Health, to include statistics, revenue, FTEs, salaries & wages, all operating expenses.

Houston, Texas, Us

• Crowe Revenue Cycle Analytics (RCA) healthcare system implementation• Provide analyses specific to net revenue performance at corporate level and for all facilities by payor groups and patient types, to identify and explain variances from budget• Prepare and calculate detailed A/R contractual and bad debt/charity reserves• Analyze monthly net revenue calculations for funded payors based on contractual rates and historical patient data• Produce monthly close schedules related to net revenue and Aged A/R• Analyzes payor performance, carve outs analysis, profitability, costs, etc. • Deep understanding of reimbursement mechanisms, contractual arrangements, and costing attributes. • Assist in maintain and administering RCA accounts receivable valuation tool.• Use, RCA, EPSi and Payment Integrity Compass (PIC)/Concuity reporting tools and data for various analysis

Abu Dhabi, Ae

• Manage the implementation of the EPSi decision support systems for budget manager (general ledger and payroll), cost manager and Product Line Analyst (PLA)• Manage the preparation, analysis and review of decision support reporting, such as divisional hierarchies, profit and loss templates, drill-down reporting, scheduled reporting and service line or product line reporting.• Coordinate the training of new and established users of the decision support system• Collaborates with finance teams to ensure financial statements, operating metrics, and KPIs are accurate and timely• Build and implement RVU model to be used in decision support system EPSi for labor, pharmacy and supplies• Participates in project planning to ensure effective use of technology and/or business process to meet business needs (i.e. EPSi productivity, Kronos, Lawson)• Align business intelligence initiatives with data warehouse projects through planning related to the Business Intelligence strategy and BI dashboards using Tableau• Overseeing the daily operation and maintenance of the EPSi Cost Accounting/Decision Support System

Houston, Texas, Us

• Responsible for Texas Medical Center-Hermann Hospital, HVI, & Children’s service line reporting, profromas, net revenue analytics• Responsible for Decision Support service line profitability, analysis, and reporting• Prepare and present net revenue payor group month-end analysis by mix, AA, APD, and CMI adjusted to explain rate and volume variances from budget• Prepare and present month-end supporting schedules such as net rate variance explanations, contractual reserve issues, CDM review, conversions, fin. class changes, and CMI analyses• Bad debt and charity financial impact and trending analyses and reporting package by admission type, payor group, adjustment codes and patient responsibility• Medicare and Medicaid point person for net revenue impact to include a detailed understating of add ons/pass thrus including capital, IME, GME, Outliers/Inliers, DSH/Dispro., bad debt, and organ reimbursement from cost report settlement• Researching government program regulations i.e. NCDs, LCD/LMRPs, Federal Register, Medicare and F.I. transmittals, bulletins, etc.• Responsible for transplant financial reporting for liver, kidney, and pancreas from a net revenue and profitability perspective as well from a Medicare cost report perspective• Budget net revenue for Medicare and Medicaid at detailed level in which net is calculated using projected and budgeted days, cases, CMI and gross revenue applied to base payments, add ons, pass thrus, etc.• Cost center statement reviews, surveys, managed care contract reviews, and expense management responsibilities• Provide additional ad hoc and presentation reporting needs to system executives, CFOs, and directors for monthly operating (MOR) meetings

Tacoma, Wa, Us

• Compile and coordinate monthly AR and reserve financial close packet.• Financial reporting of AR, contractuals, deductions, and bad debt & charity.• AR contractual reserve analysis for all hospital billing and physician billing, using zero balance account (ZBA) methodology.• Reported payor mixes, facility and consolidated (gross rev, net rev, gross AR)• Provide analytical and reporting needs to VPs, directors, consultants, auditors. • Point person in revenue cycle for providing PBCs to external auditors • Point person between revenue cycle and finance to ensure appropriate and accurate booking of revenue deductions• Create, develop and maintain EPIC Clarity or HPM reports to provide reliable and accurate data needs• Quarterly trauma reconciliation between FHS and MHS• Analyses of bad debt write-offs, contractuals, admin. adjs. revenues, etc.

Seattle, Wa, Us

• Reconcile hospital A/R from sub-ledger billing system to general ledger• A/R contractual reserve analysis for facilities, using zero balance approach• Maintain, update, and review govt. contracts in decision support system• Review payor plans from a financial impact perspective to determine financial reporting needs• Detailed understanding of healthcare billing, contracts and accounts receivables• Revenue analysis by payor, utilization, DRGs, RCCs, etc.• Other finance needs, e.g. lobbying expense analysis, federal mental health grant analysis, survey & bond insurer questionnaires• Work closely with external auditors

Tacoma, Wa, Us

• Managed Care payor contract modeling for inpatient and outpatient to include a detailed understanding of CPT/HCPCs, ICD-9s, DRGs, ASCs, APCs, and per diem/case rates• Professional data modeling using CPT/HCPCs and fee schedules• Accounts receivable contractual reserve analysis for facilities, using zero balance approach, paid claims summaries• Profitability analysis by payors, new service, or cost centers, etc.• Chargemaster (CDM) maintenance, daily supply adds, price updates, CDM monthly reporting, and CDM usage reporting• Compile and determine budget pricing at CDM and RVU level for facilities• Ad hoc extensive revenue analysis• Detailed understanding of healthcare billing, contracts and A/R

Tacoma, Wa, Us

• Responsible for AP to GL daily interfaces, error/issues resolution with McKesson vendor• Supported various accounting software systems• Performed tests for accounts payable system upgrades• Worked with materials management to streamline purchasing processes from receiving to vendor payment• Verified integrity of data through audits, reviews and analyses• Created and maintained Crystal reports for month-end reporting and ad hoc reporting for management team

Denver, Co, Us

• Analyzed & explained P&L variances for 32 end-stage renal dialysis centers• Prepared financial statements for over 30 partnerships and affiliated centers• SEC-level corporate consolidated analysis and entries, including investments using equity method• Reconciled high cost drug inventories, A/R, fixed assets, rents/leases, and other balance sheet accounts• Reviewed and analyzed A/R open accounts at patient level • Project lead in physician services analyses