ED, CA
2 weeks ago
Job Summary:
The position oversees Medicaid financial regulatory reporting, budgeting, and forecasting, Medicaid capitation cycle, and the financial impact of new Medicaid contracts, programs and policies.
Essential Responsibilities:
Strategic leadership and oversight of the following Kaiser Foundation Health Plan functions for Southern California and Hawaii:
Appropriately maximize Medi-Cal revenues by accurate and timely reporting of costs to DHCS, analyzing rate and risk adjustment data, and negotiating with DHCS and plan partners on rates.
Coordinate with CA/Hawaii Vice President Medicaid Finance, National Medicaid Senior Vice Present, California Medicaid Vice Presidents, and Northern/Southern California Regional CFOs on KFHPs Medicaid strategy.
Oversee the monthly forecasts and annual budgets for Medi-Cal capitation and supplemental revenues and expense for Southern and Northern California.
Review financial aspects of Medi-Cal contracts and rate amendments; validate rate calculation, assess financial impact and provide recommendations to support negotiations with DHCS and plan partners.
Coordinate with the California Hospital Association and KFHP Government Relations on updates to for Hospital Quality Assurance and Manage Care Organization programs; operationalize, track, forecast and account for these programs.
Oversee Private Hospital Directed Payments, Prop 56, Inter Government Transfer and other DHCS incentive programs including new programs and reporting to DHCS, disbursement of receipts and internal tracking.
Responsible for financial implementations of new DHCS programs or contract changes including additional carved in services or new benefits such as Enhanced Care Management.
Oversee reporting of all Third-Party Liability claims information to DHCS and plan partners.
Responsible for tracking and collecting Medi-Cal supplemental revenues from DHCS and plan partners.
Provide monthly certifications for all DHCS data filings submitted by KFHP.
Responsible for preparing and ensuring the integrity and completeness of data in financial reports and disclosures provided to DHCS, including Rate Development Templates (RDTs), Medical Loss Ratio, Supplemental Data Requests (SDR) and quarterly direct Medi-Cal GAAP reporting.
Communicate with DHCS, their actuaries and auditors on KFHPs financial information including contracts with Kaiser Foundation Hospital, Permanente Medical Groups, and external providers.
Member of Medicaid Executive Cabinet.
Collaborate with Actuarial Services on Medi-Cal issues including RDT and SDR review, and with Program Office on GAAP and MLR reporting to DHCS.
Grow & develop staff for succession planning with a focus on diversity & inclusion.
Build credible and effective relationships with other Regional and Program finance leaders to implement best practices, strong finance capabilities and efficient operations.
Basic Qualifications:
Experience
Minimum ten (10) years of finance experience in a complex, matrix management organization.
Minimum ten (10) years financial supervisory experience.
Education
Bachelors degree in accounting, finance, business, economics, or related field.
License, Certification, Registration
N/A
Additional Requirements:
Ability to independently solve complex issues across a diverse constituent base.
Ability to influence change, without direct control, across a large range of functions.
Successful experience in achieving results through people in a complex organization.
Preferred Qualifications:
Medicaid, Medi-Cal and/or government reimbursement experience preferred.
Master’s and/or advanced degree in accounting, finance, business, economics, or related field preferred.
Knowledge of KFHPs cost accounting and LOB models preferred.
This position has a target base salary of $229,500 to $286,875 and is eligible for incentive compensation, comprehensive health, wellness, time off, savings, and retirement benefits, as well as relocation support, as applicable.
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