Head of Finance

Head of Finance - HMOBudget and forecasting - HMOsLead annual budgeting and planning processManage cash flow and forecasting; direct all financial, project-based, and departmental accountingMonitor HMO capital levels on an individual company and consolidated level and escalate issues based on predefined internal metrics (i.e RBC, economic capital, etc)Monitor investments against HMO's investment policy and internal capital levelsLead the data analysis efforts to identify business opportunities and issues with data quality, completeness, consistency, and accuracy, mainly on the Revenue (premium) analysis and medical costs dataStatutory Health insurance and GAAP reporting - Identify areas for 3rd party support and executionEnsure compliance with regulatory reporting requirements, including researching existing and new legislation, consulting with outside advisors, and filing financial reportsOversee accounts, ledgers, and reporting systems, ensuring compliance with appropriate standards and regulatory requirementsPrepare and present financial reports and risk analysisKey liaison to external auditors and annual audit supportShared services chargebacks, transfer pricing, and Intercompany transactionsRevenue (premiums) and medical costs recognitionInternal financial controls and financial stabilityAssist management in the development, implementation and monitoring of internal financial controls and corporate policies to maintain financial stabilityVendor and project managementConduct market research and identify prospective vendors to address organizational requirementsLead negotiations and implementation with vendors to address the functional requirements of an HMOWork in collaboration with the team to identify opportunities for business process improvement and support the implementation of such changesLead the actuarial process with the 3rd party actuarial consultant for premium pricing, reserves, and proformasWork with executive management and 3rd party actuarial team on reinsurance programs, structures, marketing, contract negotiation, etc. (stop loss protection)Hands-on with TPA management, Research, Analysis and ReportingDevelop organization financial KPIs for HMO operations and performance and work in concert with the internal technical resources to operationalize a KPI dashboardResearch, evaluate, and provide guidance on regulatory, compliance, and product design issues in partnership with the teamMedical claims payments and analysis - and identification of opportunities for savings and efficienciesRisk adjustmentOversee all risk adjustment processes, including developing workflows, tracking deadlines, and managing vendor contractsWork with business leaders and clinical teams to improve clinical documentation and claims submission processesCreate work plans and ensure timely completion of projectsLead efforts to enhance coding, claims processing, and overall revenue cycle managementData Analysis: Evaluate risk adjustment strategies, perform root cause analysis, and develop interventions to improve outcomesManage relationships with vendors supporting coding, billing, and collectionsLead audit strategies and ensure compliance with regulatory requirementsBuild and develop a high-performing accounting team over time that might include a combination of internal and external resourcesQualifications Educational Requirements:A bachelor's degree in finance, accounting, economics, or a related field is requiredA CPA, CFA, or ACCA would be a strong advantageAn MBA or a master's degree in finance or accounting is an advantageExperience:At least 7-10 years of experience in finance, with a significant portion within the health insurance industryDeep understanding of the health insurance sector (specifically ACA, small and large groups, ICHRA), including regulatory requirements and financial management practices - must haveSkills:Ability to develop and implement financial strategies that align with the organization's goalsStrong analytical and problem-solving skills, with proficiency in financial modeling and data analysisProven leadership and team management skills, with the ability to mentor and develop finance teamsExcellent communication and interpersonal skills to effectively collaborate with senior management and other stakeholdersIn-depth knowledge of financial regulations and risk management strategiesFamiliarity with platforms such as NetSuite (ERP tool), Zuora, and PaymentTech is an advantage

Created: 2025-02-02