Manager, Provider Finance Reporting and Analytics

Job Summary

The Manager, Provider Finance Reporting and Analytics is responsible for managing all financial operations related to our network of healthcare providers including Participating Physician Group (PPGs), hospitals, Skilled Nursing Facility (SNFs) and other vendors focusing on Medi-Cal, Medicare, Covered CA and Personal Assistance Services Council (PASC). The Manager, Provider finance will be instrumental in ensuring accurate financial analysis, cost containment, and optimizing reimbursement processed for our provider network.

Manages all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties

Duties Continued

Oversees the analysis of all provider contracts, provider reimbursements. Prepares comprehensive reports to support decision-making and proactively identifies areas of improvement

Work closely with the finance and provider network management teams, established fair and competitive reimbursement rates for providers

Supports provider network management in contract negotiations to ensure mutually beneficial contract terms and financial arrangements in alignment with company's strategic plans and compliance requirements

Develops and manages budgets for provider reimbursement, ensuring compliance and LA Care's (LAC's) financial objectives.

Stays current with all compliance policies and procedures related to provider networks and provider payments. 

Utilizes financial reporting, historical performance, and forecasting to  predict healthcare cost trends.  Prepares and presents finance reports and metrics, communicating critical financial matters to
leadership.

Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.  

Manage staff , including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.  

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:
At least 5 years of relevant experience in healthcare finance, provider reimbursement, or managed care with a focus on Medi-Cal, Medicare or Covered California programs.

At least 3 years supervisor and/or management experience.

Preferred:
At least 7 years of relevant experience in healthcare finance, provider reimbursement, or managed care with a focus on Medi-Cal, Medicare or Covered California programs

Skills

Required:
Strong leadership and performance management skills.

Must possess a robust knowledge of and a good working relationship with the contracted provider community and healthcare delivery systems, including provider groups (PPG’s), Management Service Organizations (MSO’s), Vendors, Subcontractors, and directly contracted practitioners.

Knowledge of Diagnosis Related Group (DRG) and Medicare reimbursement, rules and guidelines, financial modeling of California Office of Statewide Health Planning and Development (OSHPD) and other industry data.

Strong ability to understand and use internal and external cost models.

Demonstration of both qualitative and quantitative analytical skills.  Proven financial analytical skills including ability to identify risks, opportunities, trends and relationships.

Proven ability to work with a diverse group of people, including physicians, support staff, coworkers and management.

Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.

Demonstrated critical thinking and problem solving skills.

Strong written and verbal communication skills.

Strong elicitation and process documentation skills.

Strong organizational and communication skills to build and foster effective relationships.

Must possess a robust knowledge of and a good working relationship with the contracted provider community 
and healthcare delivery systems, including provider groups (PPG’s), Management Service Organizations (MSO’s), Vendors, Subcontractors, and directly contracted practitioners.

Strong critical thinking and problem solving skills to help ensure successful partnerships and department quality.

Expert in Microsoft Office applications.

Preferred:
Knowledge of ICD-9 and Current Procedural Terminology (CPT) codes desired.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Required:
Travel to offsite locations for work.