Medicaid Finance Executive (ED CA HI)

The position oversees Medicaid financial regulatory reporting, budgeting, and forecasting, Medicaid capitation cycle, and the financial impact of new Medicaid contracts, programs, and policies.

• Strategic leadership and oversight of the following Kaiser Foundation Health Plan functions for Southern California and Hawaii.
• Appropriately maximize Medi-Cal revenues by accurate and timely reporting of costs to DHCS, analyzing rate and risk adjustment data, and negotiating with DHCS and plan partners on rates.
• Coordinate with CA/Hawaii Vice President Medicaid Finance, National Medicaid Senior Vice President, California Medicaid Vice Presidents, and Northern/Southern California Regional CFOs on KFHP's Medicaid strategy.
• Oversee the monthly forecasts and annual budgets for Medi-Cal capitation and supplemental revenues and expenses for Southern and Northern California.
• Review financial aspects of Medi-Cal contracts and rate amendments; validate rate calculation, assess financial impact, and provide recommendations to support negotiations with DHCS and plan partners.
• Coordinate with the California Hospital Association and KFHP Government Relations on updates for Hospital Quality Assurance and Managed Care Organization programs; operationalize, track, forecast, and account for these programs.
• Oversee Private Hospital Directed Payments, Prop 56, Inter Government Transfer, and other DHCS incentive programs including new programs and reporting to DHCS, disbursement of receipts, and internal tracking.
• Responsible for financial implementations of new DHCS programs or contract changes including additional carved-in services or new benefits such as Enhanced Care Management.
• Oversee reporting of all Third-Party Liability claims information to DHCS and plan partners.
• Responsible for tracking and collecting Medi-Cal supplemental revenues from DHCS and plan partners; provide monthly certifications for all DHCS data filings submitted by KFHP.
• Responsible for preparing and ensuring the integrity and completeness of data in financial reports and disclosures provided to DHCS, including Rate Development Templates (RDTs), Medical Loss Ratio, Supplemental Data Requests (SDR), and quarterly direct Medi-Cal GAAP reporting.
• Communicate with DHCS, their actuaries, and auditors on KFHP's financial information including contracts with Kaiser Foundation Hospital, Permanente Medical Groups, and external providers.
• Member of Medicaid Executive Cabinet.
• Collaborate with Actuarial Services on Medi-Cal issues including RDT and SDR review, and with Program Office on GAAP and MLR reporting to DHCS.
• Grow and develop staff for succession planning with a focus on diversity and inclusion.
• Build credible and effective relationships with other Regional and Program finance leaders to implement best practices, strong finance capabilities, and efficient operations.

This position has a target base salary of $243,000 to $303,750 and is eligible for incentive compensation, comprehensive health, wellness, time off, savings, and retirement benefits, as well as relocation support, as applicable.

Experience:

• Minimum ten (10) years of finance experience in a complex, matrix management organization.
• Minimum ten (10) years financial supervisory experience.

Education:

• Bachelor's degree in accounting, finance, business, economics, or related field.

License, Certification, Registration:

• N/A

• Ability to independently solve complex issues across a diverse constituent base.
• Ability to influence change, without direct control, across a large range of functions.
• Successful experience in achieving results through people in a complex organization.

• Medicaid, Medi-Cal, and/or government reimbursement experience preferred.
• Knowledge of KFHP's cost accounting and LOB models preferred.
• Master's and/or advanced degree in accounting, finance, business, economics, or related field preferred.