MAPD Finance Manager – Capitation & Compliance

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

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.