Director, Alternative Payment Model Performance

CareSource; Dayton (OH); On-site; USD 136,000 - 237,000; Full time

Job summary

CareSource seeks a Senior Director, Finance Vendor Governance to lead enterprise vendor financial strategy and contract components for medical services. You will shape policies, oversee reimbursements, and ensure alignment with MLR reporting and ROI targets.

Strong leadership, analytical, and negotiation capabilities are essential. You will collaborate with IT, Claims and Operations to ensure contracts are properly administered, drive cost savings, and report risks to Senior Management.

Qualifications

• Bachelor of Science/Arts (BA/BS) in Finance, Accounting, Math, or related field.
• MBA is preferred.
• Minimum of ten years of experience including at least five years in management.
• Experience with healthcare/insurance industry is required.

Responsibilities

• Oversee vendor contracts for medical or medical administrative services and related costs.
• Develop and manage policies for administering vendor contracts including payments, invoicing, capitation, and shared savings.
• Drive strategy in vendor contract negotiations to ensure ROI and compliance with MLR reporting and rate development.
• Develop the Finance vendor contract strategic plan and ROI targets.
• Administer an information flow to load contract payments with correct cost centers and classifications.
• Identify cost savings and consolidate vendors to improve efficiency.
• Maintain a contract provisions database and analyze cost structures for variability.

Skills

Advanced Excel

Financial analysis

Vendor management

Strategic planning

Leadership

Cost control

Contract negotiations

Interpersonal communication

Education

BA/BS in Finance/Accounting/Math

MBA (preferred)

Job description

Job Summary:

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.

Essential Functions:

• 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.

Education and Experience:

• Bachelor of Science/Arts (BA/BS) degree in Finance, Accounting, Math, or related field
• Master of Business Administration (MBA) is preferredMinimum of ten (10) years of experience to include a minimum of five (5) years of management experience is required
• Experience with companies that have both for-profit and not-for-profit entities is preferred
• Prior healthcare / insurance industry experience is required

Competencies, Knowledge and Skills:

• 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

Licensure / Certification

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• May be required to travel occasionally

Compensation Range:

$135,600.00 - $237,400.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. 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.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.