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Director Of Finance

PRIDE Health The Bronx Full-Time
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Director of Finance

Well established Managed Long-Term Care Plan is looking for a Director of Finance.

Processes monthly Medicaid Billing.

Supervises data entry of new member's information in Capitation Billing System.

Enters disenrollments in Capitation Billing System.

Processes and prepares weekly Denial Report for the Social Services Department.

Prepares "Claims Invoices" for the Entitlement Dept. to give to the State for Denied Claims.

Applies weekly Medicaid remittance in Capitation Billing System.

Supervises process of weekly rebills on denied claims.

Works with Social Work and Clinical Operations to identify and resolve problems.

Updates documented changes in member's information in Billing System.

Processes capitation refunds/credits and maintain Master Refund/Credit Excel Worksheet.

Prepares monthly invoices for doctors for A/P Department for payment.

Maintains monthly AR Aging Report.

Prepares monthly AR Reconciliation.

Processes monthly FIDA billings and enrollment reconciliation.

Processes monthly ISNP billings and enrollment reconciliation.

Prepares monthly "Return of Capitation " reports and chairs the bi-weekly meeting.

Works with Claims Department to verify vendor payments as needed.

Prepares A/P invoices sent to A/P Department for payment.

Works with Director of Analytical Reporting to respond to various audits (OMIG, OIG, OSC, etc..)

Prepare the monthly Rosters and Revenue Worksheet (MLTC, FIDA and ISNP).

Prepare the monthly AR Reconciliation/Due from/Due to Accounts (MLTC, FIDA and ISNP).

Prepare monthly FIDA and ISNP Direct Care Expense Worksheet forwarded to VP of Finance.

Works with SVP of Finance to certify monthly ISNP roster in HPMS.

Assists VP of Finance with monthly financial closing, including monthly journal entries.

Analyses and prepares Due to and due from Medicaid account monthly.

Supervise monthly billings, monthly statements, and processing of receipts for surplus.

Maintain monthly Medicare P2P and CGDP worksheets for FIDA & ISNP Plans.


CPA preferred

Medicare experience required

Health plan experience is a plus. 

Must have healthcare experience.

CPA preferred

Medicare experience required

Health plan experience is a plus. 

Must have healthcare experience.

Skills required

Financial Analysis
Internal Controls
Financial Statements
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PRIDE Health, LLC is a leading Healthcare Recruitment & Staffing firm that offers highly customized solutions and business process solutions at cost-effective prices.

Headquartered in New York, NY - Pride Technologies offers a broad geographic reach with offices throughout the U.S., India and Brazil. Leveraging more than 20 years of experience PRIDE has enhanced its core competency of IT staffing services by creating client-centric, cost-effective IT and business process solutions. PRIDE serves client-partners in the healthcare, IT, financial services, retail and insurance industries offering both Direct Hire and Temporary Staff of healthcare professionals, Vendor Management Systems, IT Hardware Procurement Services and Business Processing Outsourcing.

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