Finance Manager
Imperial Health Plan of California, Inc. · Pasadena, CA · 3 wk ago
On-siteFinanceFull-time
About the role
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.
Key Responsibilities
- Capitation Payments and Risk Adjustment: Ensure CMS H5496 capitation payments are accurately received for all enrolled members based on the application and risk adjustment factors.
- Verify the accuracy of capitation calculations by the capitation team, including IPAs (Independent Practice Associations) and PCPs (Primary Care Providers) capitation expense.
- Avoid paying claims for members for whom CMS did not provide capitation payments.
- Verify the accuracy of capitation calculations by the capitation team, including IPAs (Independent Practice Associations) and PCPs (Primary Care Providers) capitation expense.
- Regulatory Reporting And Compliance: Manage and oversee reporting requirements for DMHC (Department of Managed Health Care), TDI (Texas Department of Insurance), NAIC (National Association of Insurance Commissioners), and other regulatory requirements, as needed.
- Prepare and track IPA financial solvency for all affiliated RBO’s to present and distribute to management team.
- Maintain compliance with all applicable regulatory standards and reporting deadlines.
- Prepare and track IPA financial solvency for all affiliated RBO’s to present and distribute to management team.
- Claims Review: The Fee-for-Service (FFS) claims ensuring adherence to Division Of Financial Responsibilities (DOFR).
- Partner with the CEO, Claims Director, Claims Recovery, and others on claims settlement.
- Oversee the Claims Recovery team and Configuration to prevent errors or discrepancies that could impact financial outcomes.
- Partner with the CEO, Claims Director, Claims Recovery, and others on claims settlement.
- Financial Projections And Analysis: Develop financial projections and forecasts for multiple entities within the organization.
- Analyze financial data and trends to support decision-making and strategic planning.
- Technical And Analytical Support: Utilize SQL or other coding tools to extract and analyze financial data as needed.
- Collaborate with the data team to enhance reporting accuracy and efficiency.
- Acts as a liaison to the Information Technology Department for the creation of various database queries on utilization, membership, revenue sources, etc.
- Collaborate with the data team to enhance reporting accuracy and efficiency.
Qualifications
- At minimum, Bachelor’s degree in Finance, Accounting, Business Administration, or a related field (Master’s degree preferred).
- Extensive experience (at minimum 5 years) 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.
Preferred Skills
- Experience working in an MSO or with managed entities like Imperial Health Plan of California, Inc.
- Familiarity with CMS guidelines.
- Strong understanding of financial processes correlated to MAPD business models.