Finance Manager

Finance Manager

A growing healthcare organization is seeking a Finance Manager to lead a team of Financial Analysts and support the financial operations of multiple managed care and healthcare entities. This is a highly visible role with broad exposure to executive leadership, regulatory reporting, risk adjustment, capitation revenue, claims analytics, and strategic financial planning.

The ideal candidate will bring deep experience within the Medicare Advantage (MAPD) space and a strong understanding of healthcare finance, risk adjustment, capitation models, and regulatory reporting.

Key Responsibilities

Medicare Advantage Revenue & Capitation

• Oversee the accuracy of CMS capitation revenue and member premium payments
• Ensure risk adjustment factors are appropriately reflected in revenue calculations
• Review and validate capitation expense calculations for provider groups, IPAs, and PCPs
• Monitor member eligibility and payment activity to ensure alignment between CMS payments and claim activity

Financial Analysis & Forecasting

• Develop financial models, forecasts, and projections across multiple healthcare entities
• Analyze revenue, medical expense, utilization, and membership trends
• Provide insights and recommendations to support executive decision-making and long-term planning
• Partner with leadership on strategic initiatives and financial performance improvement

Claims & Medical Cost Oversight

• Review fee-for-service claims activity and ensure adherence to Division of Financial Responsibility (DOFR) arrangements
• Partner with executive leadership, claims operations, and recovery teams on claims analysis and settlement activities
• Monitor claims recovery and configuration processes to identify and resolve financial discrepancies
• Support efforts to improve accuracy and efficiency across claims-related processes

Regulatory Reporting & Compliance

• Manage healthcare regulatory reporting requirements and ensure timely submissions
• Support financial solvency reporting and performance monitoring for affiliated provider organizations
• Maintain compliance with applicable healthcare and insurance regulations
• Prepare financial analyses and reporting packages for senior leadership

Reporting & Data Analytics

• Utilize SQL and other analytical tools to extract, validate, and analyze financial and operational data
• Partner with data and technology teams to improve reporting capabilities
• Serve as a key liaison between Finance and IT for utilization, membership, revenue, and performance reporting initiatives
• Drive process improvements through automation and enhanced reporting solutions

Qualifications

• Bachelor's degree in Finance, Accounting, Business Administration, or related field
• 5+ years of healthcare finance experience, preferably within a Medicare Advantage, managed care, health plan, MSO, IPA, or risk-bearing organization
• Strong understanding of Medicare Advantage revenue, risk adjustment, and capitation methodologies
• Experience with fee-for-service claims, medical cost analysis, and DOFR arrangements
• Hands-on experience with healthcare regulatory reporting requirements
• Advanced analytical and financial modeling skills
• Proficiency with SQL or other data analysis tools
• Strong communication and leadership abilities

Preferred Background

• Experience within an MSO, health plan, IPA, provider risk organization, or value-based care environment
• Knowledge of CMS reimbursement methodologies and Medicare Advantage operations
• Experience supporting multi-entity healthcare organizations
• Familiarity with provider capitation, risk-bearing entities, and healthcare financial solvency reporting