Director, Revenue Premium & Recovery Billing

Full Time on W2

Job Summary

The Director, Managed Care and Revenue and Premium Billing will oversee and provide development, leadership and direction to the Medical Payment Systems and Services Revenue, Premium Billing and the Shared Risk departments. The Director will hire, train and provide development/mentoring to ensure staff are successful. The Director will manage the reconciliations of the multiple Revenue streams and financial activities to ensure accurate reporting, processing and analysis from the multiple Revenue payers. Record Rate Adjustments, Accounts Receivable, Cost Sharing Recovery, Refunds and Tax Credits, Share Risk Settlements and Claims refunds for all contracted product lines of business. The Director will communicate and collaborate with the organization business units the project updates and progress.

The Director will design, develop, configuration and implement business solutions to report accurate monthly financial activity and increase departmental efficiencies. To ensure staff is trained on all system (QNXT/MHC/Benaissance modifications. To ensure current status of data creation and updating of the Financial related components of the organization's processing systems Benaissance, MHC and QNXT.

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

Duties

Revenue: Responsible for the accurate calculation and reconciliation of Revenue from various payers. Includes Rate Adjustments, supplemental billing to contracted agencies Tax Credits and Cost Share Reserves for All Lines of Business (LOB).

Premium Billing: Responsible for the accurate per member per month (PMPM) premium billing for All LOBs; Collection of Not Sufficient Funds (NSF) and Partial paid Premiums.

Shared Risk: Responsible for ensuring all financial data shared risk data is recorded correctly through settlements.

Reconciliations: Responsible for ensuring all reconciliations and analysis, such as Cash Received are reconciled to core systems for all product lines.

Information Systems Maintenance: Responsible for ensuring all financial related data in MHC/ QNXT/ Benaissance and other integrated systems is configured correctly and maintained accurately and timely as it relates to new product development and current contracted lines of business.

Business Systems Design and Development: Responsible for developing business solutions and identify cost saving effective procedures for processing and reporting necessary financial data. All Journal Entries, General Ledger reconciliation and audit schedules are performed acutely and timely.

Develops goals, objectives and actions plans for assigned staff which includes full management responsibility for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees. Prepares briefings, reports, consultation documents and presentations that clearly articulate LA Care's regulatory position and policy. Develops regulatory position and policy based on research and evidence.

Communicates and collaborates with the organization business units the project updates and progress.

Performs other duties as assigned.

Education Required

Education Preferred

Experience

Required:
At least 7 years relevant work experience in finance/accounting. Minimum of 5-7 years of supervisory/management experience in a health care environment.

Preferred:
HMO experience in finance operations.

Experience interfacing with state or other governmental agencies.

Skills

Required:
Strong accounting, technical and systems knowledge - MHC, QNXT and Benaissance.

Excellent verbal and written communication skills.

Ability to demonstrate high level of interpersonal skills in order to gain acceptance from cross functional teams.

Ability to demonstrate diplomacy.

Full knowledge of all relevant policies and procedures when communicating with Plan Partner and/ or DHS representatives.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Additional Information