Claims and Finance Manager

Lakeland Care - Fond du Lac, WI

Full-time - Mid Level

Fond du Lac, WI

Ambulatory Health Care Services

About the position

The Claims and Finance Manager at Lakeland Care is responsible for overseeing claims, rates, and related information systems functions. This role involves ensuring compliance with contracts, providing fiscal intelligence, and supporting the Family Care program. The manager will analyze metrics, assist in financial reporting, and collaborate with various departments to enhance operational efficiency and accuracy in claims processing.

Responsibilities

• Oversee and direct claims, rates, and related information systems functions for Lakeland Care.
• Recommend and implement systems to meet contract compliance requirements and strategic goals.
• Serve as a claims advisor to LCI staff regarding fiscal aspects of the Family Care program.
• Contribute to monthly analysis of metrics to identify variances and trends.
• Assist in financial reporting and conduct various analytical assignments as needed.
• Oversee payment of provider claims and guide claims staff in responding to inquiries.
• Review provider recoupment levels and recommend actions to minimize payment errors.
• Establish and review internal controls, guidelines, and best practices for claims processing.
• Perform financial and root cause analysis and present findings to leadership.
• Ensure compliance with local, state, and federal regulations regarding claims processing.

Requirements

• Bachelor's Degree in Accounting, Finance, Statistics, Business, or related field, or equivalent experience.
• Minimum of three years of experience in complex analyses and reporting.
• Minimum of three years of experience leading claims or revenue cycle management processes.
• Ability to lead and develop staff across diverse backgrounds.
• Experience with advanced level of Microsoft Excel is required.
• Strong analytical skills and proficiency in statistical and financial analysis are required.
• Effective oral, written, and interpersonal communication skills are required.
• Knowledge of claims processing, especially Medicare and Medicaid claims, is required.

Nice-to-haves

• Certified Management Accountant (CMA) or Certified Public Accountant (CPA) is a plus.
• Experience with accounting information systems is preferred.
• Knowledge or experience with managed care and insurance industry operations is preferred.
• Knowledge of the Family Care program is a plus.

Benefits

• Work from home opportunity
• Supportive and award-winning company culture