Manager, Client Financial Services
0108169

Job Description

Reports To  Director of Operations

SUMMARY

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.

ESSENTIAL FUNCTIONS

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 measurements.

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 is provided.

Communicate updated guidelines and policies to staff.

Participate in project planning and functional management meetings.

Perform management 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 qualities.

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.

QUALIFICATIONS and EDUCATION

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 preferred.

EQUIPMENT and SOFTWARE

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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