Claims and Value Based Care Finance Manager
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Job Location:
Bloomington, IN - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
HealthPartners is hiring Claims and Value Based Care Finance Manager. The Manage provider reimbursement and FP&A support of off-system payments including value-based care (VBC) arrangements. Manage system changes related to non-standard provider reimbursements such as provider VBC arrangements. Responsible for estimating claims IBNR and claims performance reporting as part of month end process.
MINIMUM QUALIFICATIONS:
- Education Experience or Equivalent Combination:
- Bachelors degree (Finance Accounting or related) with 5 years of experience or 7 years of equivalent experience
- Knowledge Skills and Abilities:
- Health Industry Experience
- Leadership experience
- Effective communication skills written and oral
- High level of business and organization knowledge
- Excellent financial analysis skills
- Strong systems skills and ability to keep up to date with system changes
PREFERRED QUALIFICATIONS:
- Knowledge Skills and Abilities:
- Health Plan Insurance experience
- Experience with Claims Forecasting and/or IBNR estimation
ESSENTIAL DUTIES:(Includes duties that represent 10% or more of the roles time and focus)
- (20%) Manage the month end review of claims lags and IBNR estimation process along with providing reporting/analysis of claims trends and performance
- Ensure IBNR calculations and process provide most reasonable estimates. Collaborate with Accounting and Actuarial departments review and calibration of estimates.
- Review high-cost claims and stop loss claims and follow up with appropriate areas to ensure we are reserving appropriately.
- Provide reporting and analysis on monthly claims trend performance identifying key drivers and forecast variances
- (20%) Off-system Claims General Ledger and FP&A Support
- Support accounting for off-system claims general ledger accruals and provide month end reporting.
- Provide financial planning and analysis support for budgeting/forecasting and reporting of off-system claims for health plan (e.g. VBC arrangements non-adjudicate payment processes provider settlements non-claim medical expenses etc.).
- Serve as subject-matter-expert and primary finance lead for ad-hoc analysis/projections for off-system claims and for provider contracting impacts/arrangement.
- Role may present opportunities to provide additional finance oversight/support for Medical/Rx claims forecasting/projections.
- (20%) Provide oversight of the financial reporting for value-based care (VBC) arrangements
- Review VBC quarterly results for accuracy timeliness and ensure appropriate controls are in place.
- Analyze and provide summary of key trends to review with Provider Relations/Network Management team
- Review of accruals and payments for provider value-based arrangements
- Effectively summarize and report on provider settlement information
- (15%) Administer HealthPartners Provider Withhold settlement process.
- Ensure annual settlements for providers are completed accurately and all contractual deadlines are met for both provider and health plan groups.
- Oversee process of calculating annual settlements is efficient and effective controls are in place.
- (15%) Lead daily operations of Claims/Value-based Care Finance support team.
Manage team to provide work direction training cross-training development and support.
- (10%) Manage system changes related to provider value-based care (VBC) changes and withhold settlement process
- Understand systems that support provider value-based care payment arrangements
- Work with IT for any changes to provider VBC arrangements and ensure accuracy of changes through reviewing testing.
- Ensure financial reporting systems are efficient and effective internal controls exist.
- Effectively work with Provider Relations/Network Management in a team approach to bring the settlement process to closure.
Required Experience:
Manager
Key Skills
- Financial Services
- Financial Models
- Communication skills
- General Ledger Accounting
- Account Management
- ERP
- Payroll
- External Auditors
- Analytical Skills
- Credit Card
- Financial Statements
- Annual Budgets
- Business unit
- Customer Relationship
- Financial Management
About Company
At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work. We’re a nonprofit, integrated health care ... View more
