Director, Finance Vendor Governance(Capitation Experience Preferred)

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 work of others including the development, motivation and rewarding of staff
• Critical listening and thinking skills

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.