Pbm Finance Director Jobs (NOW HIRING)

PT BE 20-39 HRS Elder Service Plan - Mattapan, Mattapan, MA, US

Salary Range: $146,165.00 To $219,248.00 Annually

Harbor Health Services is an innovative, growing, mission-based organization that lives, serves and collaborates with our community members to achieve our mission to help individuals reach their full potential through access to local, affordable services that promote health. Harbor provides medical, behavioral health, dental, and support services to more than 34,000 patients in Boston, the South Shore, and Cape Cod.

Harbor Health operates twoPrograms for All-Inclusive Care for the Elderly (PACE) in Mattapan and Brockton, providing comprehensive healthcare, transportation and social services for more than 580 frail elders. We are currently seeking a talented Finance Director for our PACE Program to join our team.

Harbor Health offers an excellent, comprehensive benefits package including Health, Dental, Vision, Life, & Disability insurance, 403b Savings Plan, Generous Paid Time Off plus 11 additional Holidays and much more!

Role:

Reporting to the Chief Financial Officer (CFO), theFinance Director provides strategic financial support for Harbor’s Elder Service Plan (ESP), a Program for the All-Inclusive Care for the Elderly. Managing a team of three staff, the Finance Director ensures accurate revenue reimbursements for all enrolled participants, serve as the finance business partner to the Senior Vice President, Elder Service Plan and collaborates with senior leadership to ensure compliance with all federal and state regulatory and financial reporting requirements. The Finance Director will also drive the annual budgeting for the Elder Service PACE Program and assist in managing vendor relationships and contracts.

Responsibilities include:

• Leads the annual budget process for the Elder Service Plan PACE program.
• Analyzes Monthly Budget to Actual variances and provides financial report to the program Senior Vice President and clinical staff.
• Analyzes utilization and medical expense data and recommends changes for improved efficiency and accuracy.

Medicare and Part D

• Ensures timely and accurate submission of all Risk Adjustment Process System (RAPS) and Prescription Drug Event (PDE) data to Medicare.
• Manages the Medicare Part D bid, reporting and compliance
• Manages relationship with PBM and pharmacy vendor

Strategic Leadership and Analysis

• Recruits, hires supervises and retains all Finance Dept. staff.
• Acts as subject matter expert on all issues related to finance in a managed care setting.
• Manages Medicaid cost reporting and partners with industry groups on various projects.
• Maintains knowledge of current fiscal regulations for PACE, Medicare and Medicaid
• Leads contract discussions with hospitals and other medical providers to ensure optimal payment structures for Harbor's Elder Service Plan

Requirements:

• Bachelor's degree in Finance or related field required
• Five years of work experience in a managed care plan including two years managing staff required
• Intermediate proficiency with Microsoft Excel and Office 365 Including Word, Outlook an Teams
• Demonstrated proficiency in database management, navigation, and utilization
• Knowledge of healthcare reimbursement principles including Medicare and Medicaid
• Experience with Medicare risk adjustment factor coding and/or Medicare Part D bid and reconciliation
• Excellent verbal and written communication skills communicating with a wide audience (e.g. physicians, senior managers, patients, finance staff)
• Excellent problem-solving skills
• Highly organized to handle multiple tasks simultaneously under tight deadlines
• Ability to take initiative; work independently and as a team player
• Experience in hospital or other health care billing
• Knowledge of diagnostic coding

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

The salary range and/or hourly rate listed is a good faith determination of base compensation that may be offered to a successful applicant for this position at the time of this job advertisement.

When determining actual base salary and/or rate, several factors may be considered as applicable (e.g. location, years of relevant experience, education, training, and other factors as permissible by law). As such, most offers will not be at the top of the salary range.