Sr. Accounting Manager

About SCAN

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation's leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn; Facebook; and Twitter.

The Job

Manages the Capitation and Claims responsibilities to ensure accurate payment and timely reporting of capitation and claims expenses to support financial reporting and analysis. Oversight includes contract interpretation/analysis, system configuration and accuracy, claims expense reporting, provider risk pools and incentive programs, medical costs accruals, and data warehouse integrity.

You Will

• Ensures the efficiency and accuracy of the capitation methodology by managing the monthly capitation process, performing quality reviews, developing audit tools, certifying system integrity, reviewing and approving monthly provider capitation payments
• Achieves compliance by evaluating new, proposed, and existing contractual agreements as it relates to payment methodologies for global, full and shared risk arrangements
• Oversees the maintenance and data integrity of the capitation and shared risk modules by managing the configuration, analysis, documentation, data entry and testing of the system configuration set-up to support current operational needs, compliance requirements and future market growth
• Maintains the capitation contract grid; monitors rate structures and rate changes
• Provides analytical support to Network Management, Shared Services, Value-Based Care, and other Managed Care departments by synthesizing data from multiple sources into clear, meaningful, and concise explanations and variance analysis
• Oversees the generation of monthly provider capitation reports; responds and resolves provider inquiries; supports education on capitation arrangements
• Ensures monthly reconciliation of data in the data tables and cubes for capitation and claims.
• Reviews provider shared risk reports prepared by the team; collaborates with Managed Care departments (including Actuarial Services and Value-Based Care)
• Supports other provider payments, including performance incentives
• Owns all aspects of day-to-day accounting operations for capitation and claims, including leading the month-end close process, reviewing P&L results, ensuring Balance Sheet integrity, establishing accounting policies, procedures and internal controls, and managing interim and year-end GAAP financial audit deliverables
• Responsible for financial schedules related to capitation and claims that support the organization's regulatory financial filings and audits
• Provides support for the annual CMS and DHCS bid process by maintaining underlying data for capitation, risk pools, provider incentives, and claims
• Leads the implementation of capitation and claims processes for a new accounting system or a new healthcare core admin system (capitation module)
• Motivates, engages and develops team members by communicating job expectations, planning, providing training, developing personal growth opportunities, appraising job results, coaching, and counseling via regular 1:1's and periodic goal reviews.
• Drives process improvements to continuously improve processes; identifies control and/or process inefficiencies, proposes and implements enhancements
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN's Vision and Goals. (Change to Healthcare in Action or Homebase Medical, if appropriate)
• Other duties as assigned.

Your Qualifications

• Bachelor's degree in Finance, Accounting, Business, or related field
• 7+ years progressive experience within finance and accounting.
• 5+ years of experience within managed care finance and accounting, including capitation and claims.
• Strong knowledge of eligibility, capitation models, claims and IBNR, provider risk pools and incentive programs
• Proficiency with accounting ERP systems, Oracle is a plus
• Experience with healthcare core admin systems (capitation module)
• Demonstrated process improvements and project management experience

What's in it for you?

• Base Pay Range: $125,400 to $181,419 yearly
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, plus 1 additional floating holiday
• Excellent 401(k) Retirement Saving Plan with employer match
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

#LI-AC1

#LI-Hybrid