Director of Payer Finance (Managed Care) Corporate Office – Remote Salary + bonus Our client is a physician-led healthcare provider operating over 30 clinics, recognized as a leader in transforming care delivery. They combine innovative, physician-led care models with advanced technology and a focus on personalized, coordinated care to empower providers, especially in challenging healthcare environments. They are at the forefront of driving change in value-based healthcare. They promote work-life balance and support each employee's personal and professional goals to help them lead their best lives.
Job Summary The
Director of Payer Finance will oversee the financial management of service funds within the managed care sector. This role will focus on the reconciliation of service fund accounts, identifying discrepancies, and ensuring the accurate and timely resolution of underpayments. The Director will work closely with internal teams, external payers, and other stakeholders to ensure that financial operations align with contractual agreements, regulatory requirements, and organizational objectives.
Essential Job Functions - Service Fund Reconciliation: Oversee the monthly and quarterly reconciliation of payer service fund accounts to ensure all transactions are accurately recorded. Investigate and resolve any discrepancies between expected and actual service fund balances.
- Underpayment Resolution: Identify underpayments and billing issues by reviewing payer statements, analyzing payment trends, and coordinating with payer organizations to resolve discrepancies and ensure proper payment processing.
- Financial Reporting: Generate and analyze reports on service fund performance, payment accuracy, and discrepancies. Provide regular updates to senior leadership regarding the status of underpayments and reconciliation efforts.
- Contract Compliance: Ensure all service fund activities align with payer contracts, including terms related to payment structures, adjustments, and reconciliations. Collaborate with the contracting team to address payer-specific issues.
- Process Improvement: Identify and implement process improvements to enhance the accuracy and efficiency of service fund reconciliation. Propose new methodologies or technologies to reduce the occurrence of discrepancies and underpayments.
- Collaboration with Payers: Serve as the primary liaison with payer representatives to resolve disputes, answer inquiries, and address concerns regarding service fund balances and payment issues.
- Team Leadership: Lead and mentor a team of financial analysts or accountants responsible for day-to-day service fund management. Ensure that the team has the resources, training, and guidance necessary to meet performance goals.
- Audit and Compliance: Ensure that all financial processes related to managed care payer funds are compliant with federal and state regulations, as well as internal policies and procedures. Prepare for and participate in audits related to payer financials.
Minimum Required Education, Experience & Skills - Bachelor’s degree in Finance, Accounting, Business Administration, or related field (Master’s degree preferred).
- Minimum of 7 years of experience in payer finance, managed care finance, or related fields, with at least 3 years in a leadership role.
- Health plan experience is highly preferred
- In-depth knowledge of managed care payer systems, reimbursement structures, and service fund accounting.
- Strong analytical skills with the ability to identify discrepancies, underpayments, and other financial issues.
- Proficient in financial software and Excel, with experience in financial reporting and analysis tools.
- Excellent communication skills, with the ability to collaborate effectively with both internal teams and external partners.
- Strong problem-solving abilities and attention to detail.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Preferred Skills: Experience with payer contracts, claims processing, and regulatory compliance in a managed care setting.
Familiarity with healthcare payment models and value-based reimbursement.
Leadership experience in managing a finance-centric team
Compensation - Competitive salary and benefits package
- Potential bonus
- Opportunity to work in a dynamic and growing organization
- Collaborative work environment focused on innovation and excellence in managed care finance
At ttg, "We believe in making a difference One Person at a Time," ttg OPT. "ttg Talent Solutions is an Equal Opportunity Employer and recruiting agency. We are committed to creating an inclusive and diverse work environment and welcome applications from all qualified candidates regardless of race, color, religion, gender, sexual orientation, national origin, age, disability, or veteran status. Please note that all offers of employment are contingent upon the successful completion of a drug test and background check. We maintain a drug- and substance-free workplace to ensure the safety and well-being of all employees.