Director, Finance Vendor Governance(Capitation Experience Preferred)

CareSource Management Services LLC • Dayton, OH • 3w ago

Job Summary:
Director, Finance Vendor Governance is responsible for the administration and oversight of the monthly vendor sub-capitation payments including reconciliations of both encounter and Cash Disbursement Journal (CDJ) files. Maintain CareSource's Shared Savings Program (SSP) strategy, including contract templates, administration of the contracts, and documentation of processes. They will calculate and distribute any provider settlements and set accruals for month end close activities.
Essential Functions:
Drive accurate financial implementation of sub-capitation and risk-share calculations, including automation of core data and definitions necessary to support program launch, monitor program progress, reconcile program performance and report on operational activity
Develop and implement monthly accrual work-plans and standard financial processes with the team that include reconciling invoices to payments to encounter data (when applicable), adjustments for retrospective changes in member eligibility, and other accounting best practices
Coordinate with internal parties to ensure clear communication of program goals, milestones, and ongoing performance
Develop and maintain a suite of reporting tools and capabilities that allow the company to understand the status, financial performance, risks and benefits associated with each vendor-financial performance
Oversee the flow of data extracts and information between CareSource and its vendor-partners to ensure continuous operational success and smooth financial reconciliation, maintaining impeccable data quality and integrity, and standardizing to create efficiencies utilizing CareSource's Enterprise Data Warehouse
Perform data validation and reconciliation between CareSource and Vendors' data files
Effectively communicate with vendors on a regular basis
Perform any other job duties as requested
Education and Experience:
Bachelor's degree in business, statistics, mathematics, economics, a related field or equivalent years of relevant work experience is required
Master's or other advanced degree in related field is preferred
Five (5) years of professional experience with core medical economics principles related to utilization, unit cost, and case-mix/patient acuity
Minimum of six (6) years of professional level experience performing a broad range of healthcare data analysis and management is required
Minimum of five (5) years of management experience is required
Minimum of three (3) years of experience contributing to health plan month-end close processes
Two (2) years of experience managing the financial performance and operations associated with sub-capitated vendors such as Dental, Vision, etc.
Managed Care or healthcare experience is required
Prior experience administering capitation, shared savings, and/or other value-based contract @types is preferred
Competencies, Knowledge, and Skills:
Knowledge of administering capitation, shared savings, and/or other value-based contract @types is preferred
Skilled in developing and managing advanced claims reserving models
Extensive knowledge of government healthcare programs and regulations
Demonstrated knowledge of health plan accounting and financial operations principles
Demonstrated knowledge of and experience with modern business intelligence tools and platforms - including Microsoft Power BI and SQL languages
Proficiency with Microsoft Suite to include Excel, Word, Power Point and Outlook
Ability to work independently and manage multiple priorities
Outstanding oral and written communication skills
Ability to articulate ideas and recommendations in a concise and actionable presentation
Comfort interacting with all levels of management as well as external stakeholders
Skilled in communicating and presenting to senior leadership
Ability and willingness to make decisions
Ability to lead and direct the

Similar Jobs

Tax Manager - US Business Process Solutions - Managed Payroll Services

Deloitte • Dayton, OH • 3d ago

Finance & Accounting

Join the world's leading professional services firm assisting employers in operating payrolls for their workforce. As a Manager you will join a dynamic team delivering our US Managed Payroll Tax Services offering. Recrui...

3d ago

Go to Apply

Staff Accountant

Robert Half • Centerville, OH • 4d ago

Finance & Accounting

Description We are looking for a detail-oriented Staff Accountant to join our team in Centerville, Ohio. The ideal candidate will manage accounting operations for multiple businesses, leveraging QuickBooks and cash basis...

4d ago

Go to Apply

Universal Banker I Part Time - Teller Part Time

Peoples Bancorp Inc • Franklin, OH • 6d ago

Finance & Accounting

Build Your Future Here: Thinking of changing jobs or starting your career at a growing company with an award-winning culture? Well you are in the right place. Join us on our journey to being the Best Community Bank in Am...

6d ago

Go to Apply

Tax Senior, National Tax Controversy Services - Interest Analyzer

Deloitte • Dayton, OH • 1w ago

Finance & Accounting

Tax Senior, National Tax Controversy Services - Interest Analyzer Are you experienced in federal interest computations? Would you like to assist in resolving federal interest matters involving a vast array of taxpayers a...

1w ago

Go to Apply

Talent Manager (Finance & Accounting)

Robert Half • Dayton, OH • 1w ago

Finance & Accounting

JOB REQUISITION Talent Manager (Finance & Accounting) LOCATION OH DAYTON JOB DESCRIPTION Our Talent Managers work in a team environment and have responsibility for negotiating and developing business with new and cur...

1w ago

Go to Apply

Talent Manager (Finance & Accounting)

Robert Half • Dayton, OH • 1w ago

Finance & Accounting

1w ago

Go to Apply

Accounting Associate

Aston Carter • Trotwood, OH • 1w ago

Finance & Accounting

Accounting Associate Must be local to the Dayton, Ohio area Job Description We are seeking a diligent and detail-oriented Accounting Associate to manage administrative records of suppliers, record and verify purchase ord...

1w ago

Go to Apply