Senior Director, Provider Finance Reporting and Analytics

Job Summary

The Senior Director, Provider Finance Reporting and Analytics  (“Senior Director, PFRA”) is a strategic, analytical,  critically thinking senior leader in the Finance organization that is charged with financial oversight of provider contracting, provider network strategy, as well as all Medical Loss Ratio ("MLR") reporting and rate-related reporting for Medi-Cal, Medicare and Commercial.

The Senior Director, PFRA is responsible for providing leadership and strategic direction for all financial analytics of provider contracting risk-based arrangements, provider directed payments, quality, incentives, cost-of-care models.. This position is responsible for the financial modeling of all provider contracts, developing budget and tracking unit costs on a regular basis.

This position is also responsible for all required reporting including Medi-Cal rate development template (RDT), and financial components of Medicare Bids, Covered CA, as well as all MLR reporting to regulatory agencies.  

The Senior Director, PFRA develop, maintain, and ensure continuously strong working relationships with all key stakeholders  to ensure members have a complete and comprehensive network of providers (physicians, groups and other services), and must also ensure continuously strong working relationships with provider and facility advocacy and affinity groups, and the LA Care (LAC) entire provider network.

This position is responsible for directing all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Duties

Work closely with the Chief Finance Officer (CFO), finance and provider network management leadership, and other members of L.A. Care's (LACs) leadership team to ensure financial alignment of LACs contracting strategies, including quality, pay-for-performance arrangements and value based provider contracting.

Work with CFO and other leaders in the Finance team towards the goal of building a Best-in-class Finance team.

Create, manage and oversee  financial reporting and analysis including budgeting, forecasting and variance analysis for provider networks for  all LAC lines of business (Medicare, Medi-Cal and Covered CA, PASC)

Develop and implement a strategic financial plan to optimize provider reimbursement and improve financial performance and quality

Play a pivotal role in negotiating provider contracts, ensuring fair and mutually beneficial terms that align with LAC's financial objectives and quality of care standards.

Provide strategic financial guidance to the provider contracting teams to:  (a)  negotiate financial terms consistent with LACs annual budgets,  (b) provide estimated financial impact of Division of Financial Responsibility (DOFR) changes, and (c) provide technical and strategic guidance on all provider payment related programs including but not limited to 
directed [payments including Prop 56, Ground Emergency Medical Transportation (GEMT), facility Directed Payments, and CALAIM Programs including Enhanced Case Management, Community Supports.

Lead LAC's Medical Cost Drivers steering committee meetings - identify, track and monitor cost-savings opportunities for LAC.

Duties Continued

Provide Analytical support for provider settlement discussions and recommend changes to the operations and contract language to reduce the need for future settlements. 

In conjunction with the Provider Network Management (PNM) team, lead the strategy for value based provider contracting. 

Collaborates with PNM in the development of incentives, set of performance standards and expectations that will reward positive performance.

Oversee the development and production of financial reports, analyzing key performance indicators (KPI) and financial metrics to support executive decision-making

Work closely with actuary and finance leadership to submit all required reporting for rate development to regulatory reporting including RDTs , Medicare bids, and subcontractor MLR reporting.

Stay current on all relevant laws, regulations and policies from CMS, DHCS and DMHC ensuring compliance within the Provider Finance, Reporting and Analytics functions

Perform other duties as assigned. 

Education Required

Education Preferred

Experience

Required:
At least 10 years of experience in provider contracting and financial analysis of provider contracts  in managed care or healthcare industry. At least 8 years of supervisory/management experience. 

Preferred: 
12 or more years of experience with a minimum 8 years management experience preferred

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 OSHPD and other industry data.

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

Demonstration of both qualitative and quantitative analytical skills.

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.

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

Expert in Microsoft Office applications.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information

Required:
Travel to offsite locations for work.