Enjoy the opportunity to work based out of your home and support our award winning culture!

Position Summary:

Under the direction of the Business Senior Manager, the Claims and Finance Manager oversees and helps direct the claims, rates, and related information systems functions for Lakeland Care (LCI). Recommends and implements systems to meet contract compliance requirements and strategic goals as well as serves as Claims advisor to LCI staff in their roles as they relate to fiscal aspects of the Family Care program.

This position contributes to monthly analysis of metrics to identify variances and trends, assists in financial reporting, and conducts various analytical assignments as needed. The Claims and Finance Manager works in collaboration with management, other Finance and Accounting functions, Data Analytics and Applications support to integrate analysis and provide accurate, timely, complete, and relevant business and fiscal intelligence to organizational decision makers.

Essential Competencies:

Accountability

• Write and revise policies as needed.
• Responsible for the forecasting, assessment, and reconciliation of claims data with accompanying responsibilities in business systems analysis, workflow documentation and analysis, and technical communications for optimal performance. 
• Oversee payment of provider claims. Guide and support claims staff in responding to provider and staff inquiries regarding claims and in submitting reprocessing requests to LCI’s third party claims administrator. Review provider recoupment levels; research and recommend actions as needed to minimize payment errors and improve recoupment of overpayments.

Critical Thinking

• Establish and review internal controls, guidelines, and best practices.
• Perform financial and root cause analysis and present findings and recommendations to various levels of leadership.
• Analyze process system design and identify potential improvements and efficiencies to existing systems and processes.

Commitment to Excellence

• Oversee the processing and reprocessing of claims; establish reporting and auditing standards; ensure reported results comply with contract requirements; and align to generally accepted accounting principles and financial reporting standards.
• Regularly review and revise policies and procedures to maximize efficiencies and maintain appropriate controls.
• Promote financial competencies and narrative in a member-centered environment.

Interpersonal Awareness

• Interact with contractors, providers, auditors, customers, and LCI staff to address questions and facilitate constructive dialogue. 
• Respond to informational requests.
• Provide interdepartmental support to accomplish cross-functional goals.

Relationship Building

• Identify obstacles and address problems cooperatively as they occur. 
• Teamwork is essential at all times.
• Convey messages concisely and advise others regarding an appropriate course of action.
• Anticipate concerns of others.

Organizational Regard

• Ensure compliance with local, state, and federal government requirements and regulations, including but not limited to contract changes, overseeing annual audits, and encounter reporting.
• Coordinate staff development in competencies and appropriate upskilling.

The duties listed above are typical for this position. These are not to be construed as exclusive or all-inclusive. Other duties may be required and assigned.

Qualifications:

• Bachelor’s Degree in Accounting, Finance, Statistics, Business, other related field, or equivalent combination of education and experience (includes knowledge, skills, and abilities). Certified Management Accountant (CMA) or Certified Public Accountant (CPA) a plus.  
• Minimum of three (3) years of experience in a position requiring development of progressively more complex analyses and reporting required.
• Minimum of three (3) years of experience leading claims or revenue cycle management process and procedures required.
• Ability to lead and develop staff and others across a wide spectrum of backgrounds.  
• Ability to propose and develop metrics designed to meet organizational goals required.
• Experience with advanced level of Microsoft Excel required.
• Experience with accounting information systems preferred.  
• Demonstrated strong analytical skills and proficiency in statistical and financial analysis required.
• Ability to summarize complex and technical information for lay and expert audiences required. 
• Effective oral, written, and interpersonal communication skills required.
• Ability to function effectively in a fast-paced, evolving and team-oriented environment with multiple priorities and objectives required.
• Knowledge of claims processing, especially Medicare and Medicaid claims, required.
• Knowledge or experience with managed care and insurance industry operations and functions preferred; knowledge of Family Care program a plus. 
• Knowledge or experience with the Encounter Reporting System a plus.
• Current driver’s license, acceptable driving record and proof of adequate insurance required.  

In evaluating candidates for this position, LCI may consider a combination of education, training and experience which provides the necessary knowledge, skills, and abilities to perform the duties of this position.