What are the responsibilities and job description for the Finance Manager position at Imperial Health Plan of California, Inc.?
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 :
