Finance Manager

Imperial Health Plan of California, Inc.; Pasadena (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

Imperial Health Plan of California, Inc. is seeking a Finance Manager to oversee the Financial Analyst team and manage financial operations for MAPD and related lines of business. The role emphasizes accurate capitation revenue, DOFR compliance, and regulatory reporting.

The ideal candidate has 5+ years in healthcare finance, strong analytical skills, and hands-on experience with CMS processes and risk adjustment. On-site in Pasadena, CA; collaboration with executive leadership is essential.

Qualifications

• Bachelor’s degree in Finance, Accounting, Business Administration or related field required.
• Master’s degree preferred for senior responsibilities.
• 5+ years in healthcare, MAPD experience, and risk-adjustment familiarity.
• Strong regulatory reporting knowledge (DMHC, NAIC, etc.).
• Proficiency with SQL or similar data analysis tools.

Responsibilities

• Ensure CMS H5496 capitation payments are accurately received for enrolled members.
• Verify capitation calculations for IPAs and PCPs.
• Ensure no claims are paid without CMS capitation.
• Oversee regulatory reporting for DMHC, TDI, NAIC, and related requirements.
• Track IPA solvency for affiliated RB0s and report to management.
• Maintain compliance with all regulatory deadlines.
• Review FFS claims ensuring DOFR adherence.
• Collaborate with CEO and Claims team on settlements.
• Oversee the Claims Recovery team and prevent discrepancies.
• Develop financial projections for multiple entities.
• Analyze trends to inform planning and decision making.
• Use SQL or coding tools to extract financial data; collaborate with IT for queries.

Skills

MAPD knowledge

Risk adjustment

Regulatory reporting

Financial analysis

Communication

Leadership

Cross-functional collaboration

Problem solving

Education

Bachelor’s degree in Finance/Accounting/Business Administration

Master’s degree preferred

Tools

SQL

Job description

On-Site required

Job Title: Finance Manager

Location: Pasadena, California. On-Site required.

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.

Job Summary

We are seeking a detail-oriented and experienced Finance Manager to oversee and manage the Financial Analyst team. The Finance Manager will be responsible for key financial operations within our organization. The ideal candidate must have at minimum 5 years of experience and 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

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.
• Ensure no claims are paid for members for whom CMS did not provide capitation payments.

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.
• Prepares and tracks 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.

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.

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.

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.