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.