Director, Alternative Payment Model Performance

CareSource • Dayton, OH

2d • $135,600 - $237,400 • Hybrid

About The Position

The Senior Director, Finance Vendor Governance is responsible for executing a comprehensive financial vendor strategy at the enterprise/market level. This role includes, but is not limited to, designing, developing, negotiating, implementing, administering, and overseeing the financial components of vendor contracts providing medical or medical administrative services and their claims, capitation and/or administration costs are reported to the state, vendors or providers with shared savings arrangements, vendors providing supplemental benefits, and those vendors that have administration costs tied to quality reclass.

Requirements

• Bachelor of Science/Arts (BA/BS) degree in Finance, Accounting, Math, or related field
• Minimum of ten (10) years of experience to include a minimum of five (5) years of management experience is required
• Prior healthcare / insurance industry experience is required
• Excellent PC skills, including advanced Excel, Word and PowerPoint
• Excellent oral, written and interpersonal communication skills
• Strong analytical and problem-solving skills
• Collaborative, with the ability to effectively influence others
• Fact-based decision maker
• Strong managerial and team-building skills with ability to lead and direct the work of others including the development, motivation and rewarding of staff
• Strategic thinking skills with a strong financial acumen
• A proven track record of achievement and integrity

Nice To Haves

• Master of Business Administration (MBA) is preferred
• Experience with companies that have both for-profit and not-for-profit entities is preferred

Responsibilities

• Oversee vendor contracts for medical or medical administrative services where their claims, capitation and/or administration costs are reported to the state, vendors with shared savings arrangements, vendors providing supplemental benefits, and those vendors that have administration costs tied to quality reclass in collaboration with the IT, Claims and Operations teams that ensure the contract operational components are administered correctly.
• Develop and manage policies and procedures for administering and managing vendor contracts including payments, reconciliation, invoicing, capitation payments, and shared savings arrangements.
• Drive strategy with corporate and market partners in vendor contract negotiations supporting development of the financial components of the contract, ensuring vendor payments meet MLR reporting and rate development requirements, and establishing corporate guardrails around allowable structures.
• Develop the Finance vendor contract strategic plan including setting the strategy for Value Based Purchasing initiatives that differentiate and enable the markets to excel, assisting in setting performance metrics, ensuring ROI for the company, and achieving financial and quality targets.
• Develop and administer a strategy to ensure Accounting has the information to load contract payments including correct cost center, correct classification of the vendor costs, etc.
• Develop and execute strategy to drive cost savings and efficiencies related to vendor contracts that fall under this position including consolidating vendors and remediate remaining vendors.
• Create and maintain a database of contract provisions and results to analyze cost structures to identify variability and best practices.
• Responsible for all month end activities related to vendor contracts that fall under this position including admin accruals, variance analysis, reporting, and communication and identification of risks to Senior Management.
• Support the strategic planning process including forecasting and budgeting by providing long-term financial projections for vendor contracts managed under this position and identifying corresponding risks and opportunities.
• Support proforma work related to RFPs, new business activities, and annual product pricing related to vendor costs and lead the due diligence activities related to Vendors for potential M&A opportunities.
• Maintain external relationships with key vendor contacts to ensure alignment on payment expectations, negotiate favorable terms, obtain files needed to include provider costs in MLR calculations, rate setting and encounter reporting, and ensure compliance with financial contract components.
• Hire, train, develop and evaluate staff to build a strong, competent and talented team of high integrity finance professionals.
• Perform any other job duties as requested.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director