What are the responsibilities and job description for the Director of Finance position at Storm3?
Director of Finance - Health Maintenance Organization (HMO)
Key Responsibilities
Statutory Health Insurance and GAAP Reporting
Ensure compliance with all relevant federal, state, and local regulations by researching current legislation and consulting with external advisors to file accurate financial reports.
Oversee accounting processes, ledgers, and reporting systems to uphold adherence to applicable standards.
Prepare comprehensive financial reports and conduct risk analyses to guide decision-making.
Maintain and foster relationships with external auditors, addressing their findings and recommendations effectively.
Manage shared services chargebacks, transfer pricing, and intercompany transactions efficiently.
Supervise revenue (premiums) and medical cost recognition processes to ensure accuracy.
Budgeting and Forecasting for HMOs
Lead the entire annual budgeting and financial planning processes to ensure financial stability.
Manage cash flow and forecasting while overseeing all financial, project-based, and departmental accounting activities.
Internal Controls
Design and implement robust internal controls to secure financial integrity.
Contribute to the development of corporate policies as a member of the senior management team.
Vendor and Project Management
Conduct strategic market research to identify vendors that align with organizational needs.
Lead negotiations and oversee vendor implementation to satisfy HMO-specific requirements.
Collaborate with internal teams to drive business process improvements.
Manage the actuarial process with third-party consultants for premium pricing and reserves.
Oversee the administration of the reinsurance policy, including stop-loss protection.
Third-Party Administrator (TPA) Management, Research, Analysis, and Reporting
Develop financial KPIs for HMO operations and collaborate with technical teams to create actionable KPI dashboards.
Research and advise on compliance, regulatory issues, and product design to support strategic objectives.
Analyze medical claims payments for insights into cost-saving opportunities and efficiency improvements.
Risk-Based Capital (RBC) and Investment Policy Management
Manage RBC requirements and oversee the HMO's investment policy, ensuring alignment with financial goals.
Data Analysis for Business Opportunities
Lead data analysis initiatives to resolve issues regarding data quality and consistency related to revenue and medical costs.
Risk Adjustment
Oversee workflows for risk adjustment, track important deadlines, and manage vendor contracts effectively.
Collaborate with business and clinical teams to enhance documentation and claims submission processes.
Develop comprehensive work plans to ensure timely project completion.
Improve coding, claims processing, and revenue cycle management practices through strategic initiatives.
Conduct detailed data analyses to evaluate and optimize risk adjustment strategies and outcomes.
Manage vendor relationships for coding, billing, and collections to maintain compliance with regulatory requirements.
Recruit, mentor, and build a high-performing accounting and finance team over time.
Qualifications
Educational Requirements :
Bachelor's degree in finance, accounting, economics, or a related field is required.
CPA, CFA, or ACCA certification is strongly preferred.
An MBA or master's degree in finance or accounting is advantageous.
Experience :
7-10 years of experience in finance, with substantial exposure to the health insurance sector.
In-depth knowledge of the health insurance industry, including ACA regulations and small and large group structures.
Skills :
Expertise in crafting and executing financial strategies aligned with organizational objectives.
Advanced analytical and problem-solving skills, encompassing financial modeling and data analysis.
Proven leadership and team management capabilities, with experience in mentoring finance professionals.
Exceptional communication and collaboration skills to engage effectively with senior management and stakeholders.
Strong understanding of financial regulations and risk management practices.
Familiarity with tools such as NetSuite (ERP), Zuora, and PaymentTech is a plus.
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