Manager, Value Based Finance

Manager, Value Based Finance

The Manager, Value Based Finance leads the financial operations and analytical efforts of the fast-growing company's value-based contracts ranging through MSSP ACOs, Medicare Advantage Plans, and Commercial ACOs. This position will collaborate with various payor partners and internal stakeholders to deliver enhanced performance on value-based contracts. Duties will include financial system development, financial operations process development, process oversight, and financial analytics. Furthermore, the individual will lead the Medicare Advantage Attribution team. Works closely with the company's value-based analytics, payor contracting, and finance teams to ensure appropriate and meaningful collaboration drives results. The position works on multiple projects as a subject matter expert in a fast-paced environment for the support of executive management, physicians, and other internal clients. This position will report to the Director of Value Based performance.

We are flexible to a remote or hybrid work schedule.

Essential Duties and Responsibilities:

• Geography and Cohort Based Performance Analysis
• Maintains a working knowledge of relevant Government and third-party health care initiatives in which the company participates. It is assumed, in order to maintain these skills, that relevant seminars, books, periodicals and regulations be routinely reviewed
• Other miscellaneous reports as required
• Attribution Reporting
• Normalizes payor data to maintain appropriate and accurate financial databases
• Attribution Audit Findings and Results
• Creates, analyzes, and utilizes financial data to create reporting related to:
• Medical Loss Ratio history
• Is the go-to expert regarding system data and report building
• Cash Audit Findings and Results
• Prepares reports, presentations and other documents and presents these materials in meetings
• Identify and research anomalies and outliers in data
• Develops then oversees weekly, monthly, quarterly, annual, and ad-hoc management reports and analysis including:
• Membership estimates
• Shared Savings reconciliations
• Other miscellaneous reports as required
• Performs other related duties as assigned or requested
• Oversees tracking and reconciliation of variances in expected to actual cash collections on value-based arrangements
• Identify problematic areas and conduct research to determine the best course of action to correct the data
• Audits and contests various payor reports including:
• Per Member Per Month revenue and expense for value-based contracts
• Develops then oversees weekly, monthly, quarterly, annual, and ad-hoc management reports and analysis including:
• Maintains all reports, data models and raw data storage in a timely and accurate manner.
• Value Based Revenue Forecasts
• Participates in project teams, analyzing various new programs, projects or ventures
• Create proactive analyses comparing company results to industry data to evaluate program performance for internal management and internal clients
• Oversees tracking and reconciliation of variances in capitation and care management fee arrangements
• Enhances and refines databases to improve reporting and analysis capabilities
• Incurred but not Reported claims

Supervisory Responsibilities

This job has one direct report

Education and Experience:

Minimum:

· Bachelor’s degree

· Requires 7+ years of healthcare finance experience

· Attention to detail

· MS Office, including proficient Excel skills

· Critical thinking

· Ability to work with technical and non-technical stakeholders

· Desire to learn / Intellectual curiosity

Preferred:

• Coding skills (SQL)
• Statistics (basic understanding)
• BI tools (Tableau or PowerBI)
• Medicare Advantage and MSSP ACO experience

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Analysis/Problem Assessment – Securing relevant information and identifying key issues and relationships from a base of information; relating and comparing data from different sources; identifying cause-effect relationships.

Coaching - Facilitating the development of other’s knowledge and skills; providing timely feedback and guidance to help them reach goals.

Compassion - The responsibility to put a patient’s or person’s interests first, including the duty not to harm, deliver proper care, and maintain confidentiality.

Compliance - Employee has satisfactory completed employers required compliance training. Employee is able to demonstrate an understanding of employers Code of Conduct.

Communication - Expressing ideas effectively in individual and group situations (including nonverbal communication); adjusting language or terminology to the characteristics and needs of the audience. Good listening skills.

Delegation of Authority and Responsibility - Allocating decision-making authority and task responsibilities to appropriate direct reports; utilizing direct reports’ time, skills and potential effectively.

Developing Organization Talent - Developing direct reports’ skills and competencies by planning effective development activities related to current and future jobs.

Follow-up - Consistently maintaining a high activity or productivity level; sustaining long work hours.

Individual Leadership/ Influencing - Using appropriate interpersonal styles and methods to inspire and guide individuals (direct reports, peers, and supervisors) toward goal achievement; modifying behavior to accommodate tasks, situations, and individuals involved.

Initiative - Making active attempts to influence events to achieve goals; self-starting rather than accepting passively; taking action to achieve goals beyond what is required; being proactive. Practices self-development.

Integrity - Maintaining and promoting social, ethical, and organizational norms is conducting internal and external business activities.

Judgement/ Problem Solving - Recognizes problems and responds, systematically gathers information, sorts through complex issues, seeks input from others, addresses root cause of issues, makes timely decisions, can make difficult decisions, uses consensus when possible, and communicates decisions to others.

Maximizing Performance - Establishing performance/development goals, coaching performance, providing training, and evaluating performance.

Patient Service Orientation - Proactively developing patient/customer relations by making efforts to listen and understand the customer and their needs (both internal and external); anticipating and providing solutions to customer needs; giving high priority to patient/customer satisfaction. Ensures appropriate follow up and is their advocate in determining solutions. The employee uses a variety of communication techniques to effectively express thoughts and ideas and to understand or influence.

Planning and Organizing/ Work Management - Establishing a course of action for self and/or others to accomplish a specific goal; planning proper assignments of personnel and appropriate allocation of resources.

Results Driven & Execution - Accountable for meeting or exceeding individual and/or department goals and objectives. Committed to producing results that will achieve company objectives. Sets priorities and organizes time to meet or exceed goals, follows up, and takes personal responsibility for results whether they are positive or negative.

Teamwork/ Collaboration - Working effectively with team/work group or those outside formal line of authority (e.g., peers, senior managers) to accomplish organizational goals; taking actions that respect the needs and contributions of others; contributing to and accepting the consensus; subordinating own objectives to the objectives of the organization or team. Listens to others and values opinions.

Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Mathematical Skills

Advanced Excel skills required (Pivot tables, lookups, indexing, if statements, etc.).

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Certificates, Licenses, Registrations:

None required.

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance and talk or hear. The employee is frequently required to stand and walk. The employee is occasionally required to stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.