Imperial Health Plan of California, Inc. | Finance Manager

3 weeks ago

pasadena, United States Imperial Health Plan of California, Inc. Full time

People are the most important asset of Imperial, for this reason the difference and plurality of people, equality of opportunities, non-discrimination and inclusion in the workplace are priority and strategic factors in the Organization. Imperial maintains a strong will to promote Diversity, Equity, and Inclusion, through inclusive leadership as a lever change and business sustainability.

About Us: Join our dynamic team at Imperial Management Administrators Services (IMAS), a Management Service Organization (MSO) that manages a portfolio of healthcare entities, including Imperial Health Plan of California, Inc. (a 3.5-star MAPD plan), Imperial Insurance Companies (ACA), Imperial Health Holdings, A Professional Medical Group (California RBO), among others. We are dedicated to providing value-based care to members while maintaining compliance with regulatory requirements.

Our Mission: To deliver valuable care so that members are healthy in body, mind, and spirit to achieve their inherent potential.

Our Vision: To deliver value based care that is clinically effective, sustainable, and achieves exceptional outcome.

THIS IS IN-OFFICE - NO REMOTE IS AVAILABLE

Job Summary: We are seeking a detail-oriented and experienced Finance Manager to oversee / manage Financial Analysts and key financial operations within our organization. The ideal candidate will have a strong understanding of the MAPD business model, including reconciliation of CMS premium to revenue, Division of Financial Responsibilities (DOFR) as it relates to fee-for-service claims and capitation payment processes, and regulatory reporting requirements. This role requires a combination of deep analytical skills, financial expertise, and technical proficiency to ensure accuracy, compliance, and operational efficiency.

Key Responsibilities:

1. Capitation Payments and Risk Adjustment:

o Ensure CMS H5496 capitation payments are accurately received for all enrolled members based on the application and risk adjustment factors.

o Verify the accuracy of capitation calculations by the capitation team, including IPAs (Independent Practice Associations) and PCPs (Primary Care Providers) capitation expense.

o Ensure no claims are paid for members for whom CMS did not provide capitation payments.

2. Regulatory Reporting and Compliance:

o Manage and oversee reporting requirements for California DMHC (Department of Managed Health Care), TDI (Texas Department of Insurance), NAIC (National Association of Insurance Commissioners), and other regulatory requirements, as needed.

o Maintain compliance with all applicable regulatory standards and reporting deadlines.

3. Claims:

o Review the Fee-for-Service (FFS) claims ensuring adherence to Division Of Financial Responsibilities (DOFR).

o Partner with the CEO, Claims Director, Claims Recovery, and others on claims settlement.

o Oversee the Claims Recovery team and Configuration to prevent errors or discrepancies that could impact financial outcomes.

4. Financial Projections and Analysis:

o Develop financial projections and forecasts for multiple entities within the organization.

o Analyze financial data and trends to support decision-making and strategic planning.

5. Technical and Analytical Support:

o Utilize SQL or other coding tools to extract and analyze financial data as needed.

o Collaborate with the data team to enhance reporting accuracy and efficiency.

Qualifications:

· Bachelor’s degree in finance, Accounting, Business Administration, or a related field (master’s degree preferred).

· Extensive experience in the healthcare industry, specifically with MAPD plans and risk adjustment processes.

· Proficiency in regulatory reporting (DMHC, TDI, NAIC, etc.).

· Strong knowledge of capitation and FFS claims processing.

· Technical proficiency with SQL or other coding languages for data analysis.

· Exceptional analytical, organizational, and problem-solving skills.

· Excellent communication and collaboration abilities.

· Must have Medicare Advantage experience.

· Minimum of 5 years’ experience managing staff.

Preferred Skills:

· Experience working in an MSO or with managed entities like Imperial Health Plan of California, Inc.

· Familiarity with CMS guidelines and risk adjustment cycles.

· Strong understanding of financial processes correlated to MAPD business models.

· Experience working with Medicare Exchange.

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