Manager, Finance Vendor Governance

Job Summary:

Manager, 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. They will maintain CareSource’s capitation processes, including administration of the contracts, and documentation of processes and SOPs. This role will lead a team of analysts that provide oversight on all monthly provider payments, settlements and accruals for month end close activities related to vendor capitation and any corresponding MLR, risk corridor and/or performance level guarantees.

Essential Functions:

• Execute 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
• Execute 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
• 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 an as-needed 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 healthcare payer capitation routines, MLR calculations, and data analysis
• Two (2) years of management experience is required
• Three (3) years of experience contributing to health plan month-end close activities

Competencies, Knowledge, and Skills:

• Skilled in working cross-functionally, building inter-departmental relationships, and effectively managing conflict resolution
• Knowledge of administering capitation, shared savings, and/or other value-based contract types is preferred
• Extensive knowledge of government healthcare programs and regulations
• Knowledge of health plan accounting and financial operations principles
• 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 thinking and problem-solving 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.