Client Financial Services
Reports To Director of
Plan, direct and monitor performance
of Client Financial Services activities and accountabilities. Provide management oversight
and responsibility for meeting service level agreements for multiple clients based on the
outsourcing agreements negotiated. Serves as lead representative across multiple projects
to support ongoing CFS improvement efforts. Partner with Operations Support Services to
develop, lead, manage and oversee continuity for new business and existing process
improvements pertaining to the Client Financial Services department. Participate with
account implementation teams to plan and execute client financial service functions into
the overall operation readiness planning.
Responsible for performance
appraisals, compensation recommendations, and performance management of assigned team;
participates in hiring and firing staff; recommends changes to improve and support
business solutions and activities.
Oversee and manages initiatives
established with clients to ensure objectives are achieved.
Oversee operational functions,
including: Client premium processing and
reconciliation. Disbursement of capitation and distribution to fund pool accounts;
Fee for service payment distribution
and reporting, including data transmittal to banks and IRS where appropriate;
Research, reprocessing and reporting
for refunds and any returned payments;
Retroactive and exception processing
for all of the above;
Manage membership uploads, additions,
deletions and reporting.
Develop and monitor performance
standards within the department.
Collaborate with other Operation
Managers to ensure consistency with procedures/policies.
Provide a lead role and active
participant in Projects across the Organization.
Assist in annual budget process
preparation and oversight for departments supervised.
Monitor workflow and performance of
staff based on service level targets, production needs and other projects.
Review quality measurement results
to ensure accuracy and production goals are being met.
Assist in development,
implementation, maintenance and monitoring of performance standards and quality
Identify training needs and
coordinate with appropriate resources to ensure training requirements are met.
Work with team members to
coordinate, research and respond to client requests to ensure exceptional customer service
Communicate updated guidelines and policies to
Participate in project planning and
functional management meetings.
duties such as performance evaluations, coaching, mentoring and compensation reviews.
Serve as a member of
the Adaptis Leadership Team.
SKILLS AND ABILITIES
Demonstrate strong analytical and
problem solving skills.
Proven skills in areas of decision
making, organization, planning, management and project management.
Understanding of health care
operations, including client financial services, claims, membership and enrollment.
Proven leadership and mentoring
Team building experience.
Strong written and oral
communication and interpersonal skills.
Domain knowledge in health plan
administration, Medicaid, Managed Care and Commercial lines of business.
Self-starter and self-motivated,
able to manage resources in a remote location.
Minimum of 3 years in management
required; 5 years preferred.
Minimum 5 years experience in
financial services or health plan operations required.
Bachelor degree in Accounting,
Healthcare Management (or similar field) preferred or equivalent work experience required.
Experience in Washington
Healthy Options and Basic Health Plan administration or other state sponsored managed care
programs, Medicare regulations and Commercial health plan administration strongly
Working knowledge of Windows, MS
Office Suite, MS Project
Experience with electronic claims or
OCR, a plus.
The above is intended to describe the
general content of and qualifications for the job. It is not an exhaustive statement of
all the functions, duties, or qualifications.
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