What are the responsibilities and job description for the Director of Payer Finance position at InnovaCare Health?
Job Summary
The Director of Payer Finance will be responsible for overseeing the financial management of service funds within the managed care sector. This role will focus on the reconciliation of service fund accounts, identifying discrepancies, and ensuring the accurate and timely resolution of underpayments. The Director will work closely with internal teams, external payers, and other stakeholders to ensure that financial operations align with contractual agreements, regulatory requirements, and organizational objectives.
Essential Job Functions
Service Fund Reconciliation: Oversee the monthly and quarterly reconciliation of payer service fund accounts to ensure all transactions are accurately recorded. Investigate and resolve any discrepancies between expected and actual service fund balances.
Underpayment Resolution: Identify underpayments and billing issues by reviewing payer statements, analyzing payment trends, and coordinating with payer organizations to resolve discrepancies and ensure proper payment processing.
Financial Reporting: Generate and analyze reports on service fund performance, payment accuracy, and discrepancies. Provide regular updates to senior leadership regarding the status of underpayments and reconciliation efforts.
Contract Compliance: Ensure all service fund activities align with payer contracts, including terms related to payment structures, adjustments, and reconciliations. Collaborate with the contracting team to address payer-specific issues.
Process Improvement: Identify and implement process improvements to enhance the accuracy and efficiency of service fund reconciliation. Propose new methodologies or technologies to reduce the occurrence of discrepancies and underpayments.
Collaboration with Payers: Serve as the primary liaison with payer representatives to resolve disputes, answer inquiries, and address concerns regarding service fund balances and payment issues.
Team Leadership: Lead and mentor a team of financial analysts or accountants responsible for day-to-day service fund management. Ensure that the team has the resources, training, and guidance necessary to meet performance goals.
Audit and Compliance: Ensure that all financial processes related to managed care payer funds are compliant with federal and state regulations, as well as internal policies and procedures. Prepare for and participate in audits related to payer financials.
Minimum Required Education, Experience & Skills
- Bachelor’s degree in finance, Accounting, Business Administration, or related field (Master’s degree preferred).
- Minimum of 7 years of experience in payer finance, managed care finance, or related fields, with at least 3 years in a leadership role.
- Health plan experience highly preferred
- In-depth knowledge of managed care payer systems, reimbursement structures, and service fund accounting.
- Strong analytical skills with the ability to identify discrepancies, underpayments, and other financial issues.
- Proficient in financial software and Excel, with experience in financial reporting and analysis tools.
- Excellent communication skills, with the ability to collaborate effectively with both internal teams and external partners.
- Strong problem-solving abilities and attention to detail.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Preferred Skills:
Experience with payer contracts, claims processing, and regulatory compliance in a managed care setting.
Familiarity with healthcare payment models and value-based reimbursement.
Leadership experience in managing a finance- centric team
Why Join Us?
- Competitive salary and benefits package
- Opportunity to work in a dynamic and growing organization
- Collaborative work environment focused on innovation and excellence in managed care finance
The information listed above is not comprehensive of all duties/responsibilities performed.
Salary : $145,000 - $150,000
