Finance Manager (Remote in US)

About the position We are seeking a dynamic Finance Manager to serve as a financial leader in building and implementing a high-performing financial operations team based in Ohio. This pivotal role will support our engagement with a key client and requires regular interaction with external vendors. The manager will be responsible for overseeing weekly pay cycles, claims management, and the escalated ticket resolution process. The ideal candidate will be highly skilled in financial operations, compliance, and team leadership, with a proven ability to operate effectively in a demanding yet rewarding environment. If you are a strategic finance leader who thrives in a mission-driven, client-focused environment, we encourage you to apply!

Responsibilities

• Lead and manage all contract requirements, ensuring adherence to service level agreements (SLAs) and operational timelines.
• Oversee and perform day-to-day financial activities associated with pharmacy claims and fee-for-service claims adjudication.
• Oversee provider recoupment processes and weekly payment cycle operations, ensuring timely and accurate disbursements.
• Manage and coordinate non-risk payment process involving managed care.
• Perform quality assurance activities involving fee-for-service RX, SPBM, Med-dent, and capitation payment cycles.
• Act as the primary point-of-contact for pharmacy and fee-for-service claim payment financial topics for the client and stakeholders.
• Contribute to financial related client and stakeholder communications, outreach, and strategies.
• Update pharmacy and fee-for-service claim payment procedures and associated materials, including policies and procedures, desk-level procedures, and manuals.
• Manage escalated tickets, providing swift and appropriate resolution while maintaining high client satisfaction.
• Direct the end-to-end medical claims and single pharmacy benefit claims management processes.
• Collaborate closely with the state client and external vendors to maintain compliance and operational excellence.
• Establish and foster a high-performance team environment focused on accountability, results, and continuous improvement.
• Provide clear leadership in managing people, driving team development, and nurturing a culture of excellence.
• Demonstrate advanced knowledge of business operations, finance, and technical processes to support administrative functions and cross-functional collaboration.
• Proactively identify and pursue business opportunities while resolving complex financial and operational issues, especially within claims management.
• Ensure compliance with all applicable federal, state, and local regulations related to finance and claims processing.

Requirements

• Bachelor's degree in finance, Accounting, Business Administration, or a related field (master's degree preferred).
• 5+ years of experience in a leadership or managerial role in healthcare finance operations (required).
• Proven experience managing remote teams and creating productive, collaborative remote work environments (preferred).
• Strong knowledge of claims processing, particularly medical and pharmacy claims.
• Medicaid and PBM claims experience (preferred).
• Experience managing vendor relationships and working directly with government clients is highly preferred.
• Exceptional organizational, analytical, and communication skills.

Nice-to-haves

• Experience with using Vue360 and/or Vue360Rx.
• Ability to create and analyze data using SQL.
• Functional knowledge of Service Now (required).
• Functional knowledge of Flexi or other payment gateway systems (required).
• Functional knowledge of Administrator (required).
• Functional knowledge of Cypress (preferred).
• Functional knowledge of Letter Manager (preferred).
• Functional knowledge of Report Manager (preferred).
• Functional knowledge of Citrix (preferred).
• Functional knowledge of Remote Desktop for servers (preferred).

Benefits

• Health (medical, dental, vision) benefits start on day 1 of employment.
• Company match 401K and other benefits available within months of starting.
• Employees are eligible to take advantage of flexible vacation policy after ninety (90) calendar days of employment.
• Company provided computer for work use.

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