Description
Innovative Integrated Health Community Plans
WHO WE ARE:
Headquartered in Newport Beach, Innovative Integrated Health Community Plans, Inc. (IIHCP) is a mission-driven organization serving seniors in California. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Responsibilities:
The Director of Finance is responsible for maximizing the return on financial assets by establishing financial policies, procedures, controls and reporting systems. This position will generate forecasts and analyze trends income, operating expenses, provider performance, provider contract performance, product line profitability, membership, medical costs, premium yields, and other areas of business, as well as ensure legal and regulatory compliance for all accounting and financial reporting functions.
Duties include, but not limited to:
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Works with CFO and CEO to establish annual medical expense and administrative budget for board approval. - Supports preparation and filing of all required reports to the California Department of Managed Care (DMHC) and to CMS, including working with actuaries and other parties to ensure all filings are complete and accurate
- Prepares IBNR reserve calculations in conjunction with CFO, external auditors and actuaries to maintain working model and ensure DMHC Tangible Net Equity (TNE) requirements are met
- Supports the CFO in preparation of monthly or quarterly board financial reporting package and provide information and analysis as requested by board members or CEO
- Conducts or coordinates premium/enrollment reconciliation activities to ensure CMS and downstream provider capitation payment accuracy and ensures health plan reports over or under payments to CMS within statutory timeframes
- Conducts or oversees medical trend analysis reporting and analysis
- Develops medical earnings improvements in collaboration with the CEO and CMO and creates the necessary tools to measure effectiveness
- Supervises assigned staff and IIH intercompany support relationships to accomplish the goals of the IIHCP and IIH finance departments
- Supports financial decisions by establishing, monitoring and enforcing health plan policies and procedures
- Executes against strategic, tactical, and operational goals in partnership with leadership team and cross-functional partners. Navigates and influences multiple cross-functional teams in a complex, matrixed work environment
- Defines short and long-term roadmap for analytical reporting for revenue and programs, to ensure performance improvement, program compliance, and financial objectives are achieved
- Develops and produces analytics to support product development and engages and supports actuarial consultants as needed, to offer industry-leading, competitively priced Medicare Advantage (MA) and Part D products and annual MA product bid(s) to CMS.
- Collaborates with cross-functional partners and health plan Management Services Organization (MSO) and Pharmacy Benefit Administrator (PBM) to reduce the impact of payment errors, implement process improvements and increase provider satisfaction
- Implements an accounting process to facilitate the reconciliation of provider refunds, vendor invoices and open receivables.
- Ensures organization can meet compliance reporting requirements for state and federal regulators
- Partners with Compliance and Provider Network Management departments to develop delegated network financial oversight program, including claims payment processes, regulatory compliance, reporting requirements and financial stability
- Partners with Compliance department on oversight of CMS-initiated audit programs and defining / executing upon internally developed audit programs
- Establishes a trusted-advisor relationship with CMS and respond to their inquiries
- Partners with Corporate IT to ensure necessary technology is available to support accurate and complete warehousing and transmission of financial and other data
- Works with leadership team and cross-functional partners on the design and development of prospective and retrospective risk adjustment programs
Competitive Benefits and Salary:
- Desirable work schedule
- Life Insurance
- Health Insurance Coverage (Medical, Dental and Vision)
- 401K
- Paid time off (including holidays, vacation and sick time)
- Competitive Salaries and bonuses
- Recruitment Referral Bonus Program
- Free covered parking located downtown
- CPR classes
- Professional development opportunities
- Employee Recognition events and activities
- Please contact Human Resources for salary information
Business Hours: Monday – Friday / 8:00 a.m. to 5:00 p.m.
. Requirements:
- Bachelor’s degree in a business, financial or related field or equivalent work experience
- Master’s level of education within Business or Finance and demonstrated corporate experience strongly preferred
- Minimum of seven (7) years of demonstrated MA financial leadership experience
- Demonstrated experience and a track record of leading a team and cooperating with leadership in a collaborative and results driven environment
Source: Indeed.com
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