Accounting Manager; Capitation & Claims

Overview

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

Manages the capitation and claims accounting responsibilities to ensure accurate and timely reporting of capitation and claims expenses to support financial reporting and analysis. Oversight includes contract interpretation/analysis, capitation and claims expenses, provider shared risk pools and incentive programs, medical costs accruals, data warehouse integrity and regulatory reporting.

• Owns all aspects of day-to-day accounting operations for capitation and claims, including managing the month-end close process, reviewing P&L results, ensuring Balance Sheet integrity, and establishing accounting policies, procedures and internal controls

• Evaluates new, proposed, and existing contractual agreements as it relates to payment methodologies for global, full and shared risk arrangements to support accounting and reporting

• Monitors capitation rate structures and rate changes to support explanations for financial fluctuations and variances against budget and forecasts;
  Provides analytical support to Network Management, Shared Services, Value-Based Care, and other Managed Care departments by synthesizing data from multiple sources into clear, meaningful, and concise explanations and variance analysis

• Leads the team in responding to and resolving provider inquiries; supports education on capitation arrangements

• Ensures monthly reconciliation of data in the data tables and cubes for capitation and claims;

• Reviews and approves balance sheet account reconciliations to ensure accuracy and completeness

• Reviews provider shared risk reports prepared by the team; collaborates with Managed Care departments (including Actuarial Services and Value-Based Care)

• Manages other provider payments, including performance incentives and admin fees

• Responsible for financial schedules related to capitation and claims that support the organization's regulatory financial filings and audits;
  Manages interim and year-end audit requests for GAAP financial audits and regulatory financial examinations;
  Provides data support for annual CMS and DHCS bid processes, including capitation, shared risk pools, provider incentives, claims and other medical costs

• Motivates, engages and develops team members by communicating job expectations, planning, providing training, developing personal growth opportunities, appraising job results, coaching, and counseling via regular 1:1's and periodic goal reviews.

• Drives process improvements to continuously improve processes; identifies control and/or process inefficiencies, proposes and implements enhancements

• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

• Actively support the achievement of SCAN's Vision and Goals.

• Other duties as assigned.

• Bachelor's Degree or equivalent experience

• Management level finance and accounting experience at a health insurance company, integrated healthcare system, or provider network, preferred.

• Experience with Medicare…