Healthcare (Accounting/Finance)-Cost Containment M
Job Opportunity at Premier Health Careers, Inc/ Premier Paths

Posted on Jul 18

http://www.premierpaths.com    504-905-7387

Location: Los Angeles, CA
Job Type: Full Time
Job ID: W4163899

We are looking for an individual with an Accounting or Finance background in the healthcare industry with 7-10 years of experience working in the managed care field for a provider (Medical Group) or payer (Health Plan) with a focus on finance, claims, or recovery.
It is essential to have a strong analytical skill set, strong oversight ability and root-cause analysis approach to problem solving.
Our client is located in the central portion of the southern San Fernando Valley and on the north slope of the Santa Monica Mountains.
Here are some of the must haves our client is looking for in a qualified candidate:
  • Demonstrated experience in providing leadership for finance, claims, or contracting function within health care.
  • Knowledge and use of claims systems and pricing is preferred. 
  • Strong analytic and strategic-thinking skills. 
  • Understanding of Six Sigma or other process improvement methodology is a plus.
Here is some of what you can expect to be DOING on a daily basis:
  • Build cost containment function for oversight, tracking and reporting of client recovery efforts.
  • Oversight, the audits, which includes the tracking and collection of claim overpayments.  This includes duplicates, eligibility, coordination of benefits, out of area, DOFR and provider contract payment.
  • Oversight and tracking of capitation revenue deductions or additional revenue available including claims deducts, ESRD revenue, OB Kick, etc.
  • Create a client level tracking system that shows dollar amounts of each cost containment bucket, as well as identifying the root cause of overpayments.  Work with each stakeholder to reduce future overpayments.
  • Identify all areas of cost containment savings, including Coordination of Benefits (COB), Third Party Liability (TPL), etc.  Build and execute recovery plan with tangible recoveries by client.
  • Understand VBC’s management services agreements (or change control notices) with each client and ensure obligations are reported according to contract and service level agreements.
  • Oversight of Revenue Recovery Analysts
This is an Associate level position and starts at $ 90K and goes into the low $ 100K range. Salary depends on years of experience.  Relocation package is offered. We have placed professionals with this company and we will help you through every step of their interview process. Our client offers a very robust benefits package including 401K, PTO, Full medical coverage and so much more.
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