Director Financial Compliance - Managed Care Health Plan 23-01300

Position
Director of Financial Complance
Managed Care Health Plan
Description

Under the direction of the Senior Director of Financial Compliance, the Director of Financial Compliance is responsible for leading, directing, and coordinating all auditing and monitoring activities related to financial viability and claims processing requirements. The Director, Financial Compliance is responsible for the oversight and operational activities of the following units: IPA Financial Compliance, Internal Claims Oversight, Delegated Network Claims Oversight, and Overpayment Reconciliation and Reporting.

• Responsible for the oversight of all functional areas of the Financial Compliance Department.
• Provide leadership in the development, implementation, and coordination of audits for the financial and claims processing oversight of delegated entities.
• Oversee the compliance and financial viability of all delegated entities through monitoring, auditing, and reporting.
• Direct the organization, review, and timely submission of the sub-contractor Medical Loss Ratio (MLR) reporting to the State.
• Oversee the collaboration of data collection and reporting for the Rate Development Template (RDT).
• Direct and oversee the Internal Claims Oversight team to include routine audits, focused audits, reporting and feedback.
• Collaborate with Provider Services, Contracting, Claims and Configuration to reduce the impact of payment errors, implement process improvements and increase Provider satisfaction.
• Oversee the accounting process of reconciling Provider refunds, Vendor invoices and open receivables.
• Direct the reporting process to assist the Auditing, Accounting, Claims and Provider Services Teams to identify areas for auditing and process improvement opportunities, using relevant dashboards for each Team and report cards summarizing Providers' performance.
• Encourage and facilitate LEAN Process Improvement activities to improve operational processes and procedures.
• Participate, practice, and promote the Health Plan Mission, Vision and Values, and Strategic Priorities to all Team Members, building effective Team Member engagement and enterprise-wide collaboration.
• Provide coaching and guidance to the Management Team to ensure collaboration and empowerment for all Team Members.
• Any other duties as required ensuring Health Plan operations are successful.

Requirements

• A minimum of seven (7) years of experience leading, managing and motivating teams in a Managed Care environment is required. Five (5) years of experience overseeing claims processing and financial viability audits required.
• Must have knowledge of the principles and practices of Managed Care as well as Medi-Cal and Medicare programs, regulations, and reporting requirements.
• Must have knowledge of Generally Accepted Accounting Principles (GAAP) and solid understanding of DMHS, DHCS, and CMS rules governing Financial Compliance.
• Strong leadership, sound decision-making and strong organizational skills.
• Excellent oral and written communication skills.

Education

• Bachelor's degree in Accounting, Finance, Healthcare Administration, or other related field from an accredited institution required.
• In lieu of the required degree, a minimum of eight (8) years of additional relevant work experience is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above.
• Master's degree in Business Administration, Accounting, Finance, Public Health, or related field from an accredited institution preferred.

Additional Information
Full-Time, Benefited Position
Hybrid
INDH