Capitation Manager at Alliance Health in Morrisville, North Carolina

Job Description:

The Capitation Manager is responsible for the accuracy and completeness of capitation payments, monitoring the trend of resolution of outstanding accounts, and reconciliation of vendor and/or provider capitated payment arrangements. The Capitation Manager will become the subject matter expert for all things related to capitation and eligibility and be a resource for the organization.

Responsibilities & Duties-

Resolve financial records related to Alliance’s capitation payments

• Work with internal staff, including IT, Claims and/or Eligibility and Enrollment, and the State to resolve outstanding records. This may involve communication with local Departments of Social Services as well. 


• Track the resolution of State submitted reports to ensure tickets can be closed.


• Conduct Monthly capitation reconciliation and trend analysis


• Complete monthly reconciliation between the monthly files from the State and Alliance’s membership on file based on the Global Eligibility File and the Innovations and TBI Slot Tracking Reports to establish Accounts Receivable for monthly and yearly financial reports.  


• Compile and validate capitation payment data to ensure payments are timely and accurate.


• Monitor trends looking for unusual changes or increased/decreased growth.  Perform regular analysis and reporting of capitation trends.  Identify drivers of variances and presents findings.  Compare Alliance results to any Statewide trends. Prepare information for leadership review.


• Comply with State requirements in sending monthly reports that detail a summary of records unresolved.


• Under Tailored Plan, complete monthly reconciliation of capitated arrangements to ensure invoices are paid correctly and/or payments are made according to accurate eligibility. 

Develop vendor reconciliation processes

• Working with internal staff and Alliance contracted vendors, establish a process and protocol to reconcile payments based on Alliance membership, contract arrangement and submitted invoices. 

Improve reporting capabilities

• Evaluate all MSTR reports related to membership and capitation payment for their usefulness and accuracy. 


• Recommend changes to aid in the ability to effectively manage our capitation records.  


• Help develop routine and ad-hoc reports for internal review

Develop Unit goals and objectives

• Work with executive and senior management to establish thresholds and targets related to collectible capitation accounts.


• Complete research, analyze data, and make recommendations regarding thresholds and targets for the financial benefit of the organization

Manage and Develop Staff

• Work with Human Resources and the Director of Accounting and Finance to maintain and retain a highly qualified and well-trained workforce.  


• Ensure staff are well trained in and comply with all organization and department policies, procedures, and business processes.


• Organize workflows and ensure staff understand their roles and responsibilities.


• Ensure staff have the needed tools and resources to achieve organizational goals and to support employees and ensure compliance with licensure, regulatory, and accreditation requirements.


• Actively establish and promote a positive, diverse, and inclusive working environment that builds trust.  


• Ensure all staff are treated with respect and dignity


• Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members.


• Work to resolve conflicts and disputes, ensuring that all participants are given a voice.


• Set goals for performance and deadlines in line with organization goals and vision.


• Effectively communicate feedback and provide ongoing coaching and mentoring to staff and support a learning environment to advance team skills and professional development

Minimum Requirements-

Bachelor's degree in Business Administration, Finance, Public Policy, Hospital Administration, or a related field and five (5) years of experience in business management or administrative business/government financial systems ;

or

Master’s degree in Business Administration, Finance, Public Policy, Hospital Administration, or a related field and three (3) years of experience in business management or administrative business/government financial systems ;

Knowledge, Skills, & Abilities-

• Thorough understanding of financial and administrative procedures


• Proficient with or able to quickly learn the administrative and financial systems and applications used in the organization


• Ability to analyze data, make independent decisions based on analysis, and report outcomes.


• Ability to report out results to all levels of leadership


• Strong skills for positive leadership


• Ability to establish Effective Internal/Work Group Relationships


• Strong written and oral communication skills


• Advanced skills with Microsoft products, particularly Excel and Access


• Ability to resolve complex problems that require the evaluation of alternative methods and solutions


• Ability to set objectives, delegate, and prioritize workflow


• Ability to make prompt decisions on complex matters and make evaluations concerning day to day operations


• Ability to plan, organize, supervise, and review the work of subordinate employees and supervisors


• Ability to work under pressure and meet established deadlines

Salary Range

$68,359 - $117,679

Education

Preferred

• Bachelors or better in Accounting


• Bachelors or better in Business Administration

Skills

Required

• Communication


• MS Excel


• Financial Analysis


• Leadership

Preferred

• Critical Thinking

Behaviors

Required

• Team Player: Works well as a member of a group


• Innovative: Consistently introduces new ideas and demonstrates original thinking


• Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well

Motivations

Preferred

• Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work


• Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization

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