Responsible for the financial and accounting activities of the LIFE program, including developing and implementing financial policies and procedures. Responsible for the development and maintenance budgeting and cost accounting function, census data, cost reports, prepare financial management reports and participate in corporate planning function. Satisfy compliance reporting requirements of public and private agencies (PACE, government, CH, internal management). The employee interacts with program staff and managers on a daily basis and has access to confidential information as necessary to perform job duties. Therefore, the employee is expected to respect the right to privacy and security of PHI (Protected Health Information) and EPHI (Electronic Protected Health Information). Positive and effective interpersonal/communication skills are required.
The Manager, Finance will be responsible for oversight of claims administration and processing, including managing relationships with the plan's Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM). In addition, this role will be responsible for annual Part D bid development and program compliance oversight, including being key liaison with LIFE's Part D Actuary/Consultant. This role will manage LIFE's capitated payments; including monitoring the plan's Risk Adjustment score to ensure accuracy and completeness of payments. This position will provide oversight of LIFE's coder and the Plan's Medicare Risk Adjustment Consultant in addition to State and Federal compliance oversight including sending quarterly reports to the compliance committee.
Bachelor's degree in Accounting, Business, or Finance required
CPA and/or MBA preferred
Three (3) to five (5) years progressive healthcare financial management experience required
Health Maintenance Organization experience in a capitated environment preferred