Director of Payer Finance (Managed Care)
Healthcare | Provider Side | provider-focused finance
Location : Remote – US only
- The ideal candidate is a finance professional with 7 years of experience in Payer Finance, (including at least 3 years in a leadership role) within the provider space with exposure to Managed Care Organization (MCO).
They should have direct experience with “provider service fund reconciliations” and financial management, along with a strong understanding of healthcare reimbursement models. Strong analytical skills, attention to detail, and a solid grasp of healthcare finance and provider contracts are essential. Experience in a provider-focused finance role is preferred.
About the Client : Our client is a physician-led healthcare provider operating over 30 clinics, recognized as a leader in transforming care delivery. They combine innovative, physician-led care models with advanced technology and a focus on personalized, coordinated care to empower providers, especially in challenging healthcare environments. They are at the forefront of driving change in value-based healthcare. They promote work-life balance and support each employee's personal and professional goals to help them lead their best lives.
Job Summary :
The Director of Payer Finance (Managed Care) will oversee the financial management of service funds within the managed care sector, with a focus on the reconciliation of service fund accounts, identifying discrepancies, and resolving underpayments. This role requires recent health plan exposure , particularly in finance roles related to provider services, and will work closely with internal teams, external payers, and stakeholders to ensure 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 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.Health Plan Finance Exposure : Bring recent, hands-on experience in health plan finance , specifically in the provider space, to drive efficient service fund reconciliations. Collaborate with payer representatives to resolve disputes and answer inquiries related to provider service fund balances and payments.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 from the Provider SideRecent experience , particularly in finance roles tied to “provider services and fund reconciliations” requiredIn-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 - managed care setting.Familiarity with healthcare payment models and value-based reimbursement.Leadership experience in managing a finance-centric team.Compensation
Competitive salary (based on experience) and benefits package, PTO, and more
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