Claims and Value Based Care Finance Manager

HealthPartners • Bloomington, MN

5h

About The Position

HealthPartners is hiring Claims and Value Based Care Finance Manager. The Manage provider reimbursement and FP&A support of off-system payments, including value-based care (VBC) arrangements. Manage system changes related to non-standard provider reimbursements such as provider VBC arrangements. Responsible for estimating claims IBNR and claims performance reporting as part of month end process. MINIMUM QUALIFICATIONS: Education, Experience or Equivalent Combination: Bachelor’s degree (Finance, Accounting, or related) with 5+ years of experience or 7+ years of equivalent experience Knowledge, Skills, and Abilities: Health Industry Experience Leadership experience Effective communication skills, written and oral High level of business and organization knowledge Excellent financial analysis skills Strong systems skills and ability to keep up to date with system changes PREFERRED QUALIFICATIONS: Knowledge, Skills, and Abilities: Health Plan Insurance experience Experience with Claims Forecasting and/or IBNR estimation ESSENTIAL DUTIES: (Includes duties that represent 10% or more of the role’s time and focus) (20%) – Manage the month end review of claims lags and IBNR estimation process along with providing reporting/analysis of claims trends and performance Ensure IBNR calculations and process provide most reasonable estimates. Collaborate with Accounting and Actuarial departments review and calibration of estimates. Review high-cost claims and stop loss claims and follow up with appropriate areas to ensure we are reserving appropriately. Provide reporting and analysis on monthly claims trend performance, identifying key drivers and forecast variances ( 2 0%) – Off-system Claims General Ledger and FP&A Support Support accounting for off-system claims general ledger accruals and provide month end reporting. Provide financial planning and analysis support for budgeting/forecasting and reporting of off-system claims for health plan (e.g. VBC arrangements, non-adjudicate payment processes, provider settlements, non-claim medical expenses, etc.). Serve as subject-matter-expert and primary finance lead for ad-hoc analysis/projections for off-system claims and for provider contracting impacts/arrangement. Role may present opportunities to provide additional finance oversight/support for Medical/Rx claims forecasting/projections. (20%) – Provide oversight of the financial reporting for value-based care (VBC) arrangements Review VBC quarterly results for accuracy, timeliness and ensure appropriate controls are in place. Analyze and provide summary of key trends to review with Provider Relations/Network Management team Review of accruals and payments for provider value-based arrangements Effectively summarize and report on provider settlement information ( 15 %) – Administer HealthPartners Provider Withhold settlement process. Ensure annual settlements for providers are completed accurately and all contractual deadlines are met for both provider and health plan groups. Oversee process of calculating annual settlements is efficient, and effective controls are in place. ( 15 %) – Lead daily operations of Claims/Value-based Care Finance support team. Manage team to provide work direction, training, cross-training, development and support. ( 1 0%) – Manage system changes related to provider value-based care (VBC) changes and withhold settlement process Understand systems that support provider value-based care payment arrangements Work with IT for any changes to provider VBC arrangements and ensure accuracy of changes through reviewing testing. Ensure financial reporting systems are efficient, and effective internal controls exist. Effectively work with Provider Relations/Network Management in a team approach to bring the settlement process to closure.

Requirements

• Bachelor’s degree (Finance, Accounting, or related) with 5+ years of experience or 7+ years of equivalent experience
• Health Industry Experience
• Leadership experience
• Effective communication skills, written and oral
• High level of business and organization knowledge
• Excellent financial analysis skills
• Strong systems skills and ability to keep up to date with system changes

Nice To Haves

• Health Plan Insurance experience
• Experience with Claims Forecasting and/or IBNR estimation

Responsibilities

• Manage the month end review of claims lags and IBNR estimation process along with providing reporting/analysis of claims trends and performance
• Ensure IBNR calculations and process provide most reasonable estimates.
• Collaborate with Accounting and Actuarial departments review and calibration of estimates.
• Review high-cost claims and stop loss claims and follow up with appropriate areas to ensure we are reserving appropriately.
• Provide reporting and analysis on monthly claims trend performance, identifying key drivers and forecast variances
• Support accounting for off-system claims general ledger accruals and provide month end reporting.
• Provide financial planning and analysis support for budgeting/forecasting and reporting of off-system claims for health plan (e.g. VBC arrangements, non-adjudicate payment processes, provider settlements, non-claim medical expenses, etc.).
• Serve as subject-matter-expert and primary finance lead for ad-hoc analysis/projections for off-system claims and for provider contracting impacts/arrangement.
• Provide oversight of the financial reporting for value-based care (VBC) arrangements
• Review VBC quarterly results for accuracy, timeliness and ensure appropriate controls are in place.
• Analyze and provide summary of key trends to review with Provider Relations/Network Management team
• Review of accruals and payments for provider value-based arrangements
• Effectively summarize and report on provider settlement information
• Administer HealthPartners Provider Withhold settlement process.
• Ensure annual settlements for providers are completed accurately and all contractual deadlines are met for both provider and health plan groups.
• Oversee process of calculating annual settlements is efficient, and effective controls are in place.
• Lead daily operations of Claims/Value-based Care Finance support team.
• Manage team to provide work direction, training, cross-training, development and support.
• Manage system changes related to provider value-based care (VBC) changes and withhold settlement process
• Understand systems that support provider value-based care payment arrangements
• Work with IT for any changes to provider VBC arrangements and ensure accuracy of changes through reviewing testing.
• Ensure financial reporting systems are efficient, and effective internal controls exist.
• Effectively work with Provider Relations/Network Management in a team approach to bring the settlement process to closure.

What This Job Offers

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