Job Description

GENERAL SUMMARY:

The Chief Finance Officer (CFO) will oversee all strategic and operational financial management related to the Population Health Services Organization (PHSO) and serve as a strategic business partner to the executive leadership team. The CFO will also oversee the improvement of clinical documentation accuracy for Medicare and Exchange members. While under the direction of the PHSO Executive Leader, the CFO will have matrix reporting to a Senior Finance Officer. Managing a portfolio of risk with over $5 billion in covered expenses and 625K lives, this role provides leadership across a multistate health system that includes multiple CINs and ACOs. This includes bundle programs with over 13,500 episodes and $395M in program size. The Chief Finance Officer is responsible for the financial management of the health care strategies, accounting, budgeting, forecasting, vetting new opportunities, planning, and overall deployment of the Population Health strategic initiatives in support of AdventHealth and its mission. Leading a team that includes Actuaries, Accountants, Financial Analysts, and Clinical Documentation Specialists, this role is the single point of contact for evaluating risk contracts, performance, provider incentives, financial close, budget, projecting of all risk arrangements, and clinical documentation engagement and accuracy. The CFO will establish and maintain productive relationships and strong partnerships with a wide range of key stakeholders across AdventHealth and its business relationship partners. In partnership with leadership, this role will be set and direct the strategic direction for risk management, including grow, diversify, move deeper into risk, and execute on performance of the portfolio. The CFO will serve as the population health subject matter expert, continuing the development of advanced population health processes, technology and system wide expertise.

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES :

• Accountable for and oversees or performs all aspects of financial management for the Population Health Services Organization and associated entities (E.g., CINs, ACOs, RBEs, etc.) including:
• Financial leader of our Health First Health Plan and risk based Joint Venture financials, product bid cycle and related third-party activities.
• Leads financial management, modeling and actuarial services for all risk-based and value-based contracts.
• Partners with the Business Development team in the financial structure, actuarial services, development and optimization of payor arrangements.
• Accountable for reporting financials on contract performance and identifying opportunities for financial, revenue and utilization improvements of risk-based arrangements.
• Financial leadership of Clinically Integrated Network (CIN) initiatives and financial management of Accountable Care Organization (ACO).
• Design and administer network physician compensation models and incentive distribution.
• Lead and oversees all system financial aspects of government programs such as BPCI-A, CJR, MSSP and ACO REACH.
• Leads the team accountable for budgeting and accounting preparation of financial statements for all individual programs, CINs, and the consolidated PHSO entity.
• Responsible for leading government/regulatory relationships and compliance, including all regulatory and rate filings.
• Serve as the executive liaison to our legal and compliance team within AH.
• Maintaining matrix reporting relationship to Senior Finance Officer.
• Provide technical, financial advice as well as guidance and knowledge to the executive leadership team, department management and finance staff.
• Provide deep understanding and guidance on all contracts and business lines, including Direct-To-Employer, Commercial, ACA Exchange, Medicare, Medicare Advantage, Bundles, and other Network arrangements.
• Partner with operators to educate medical groups and providers on financial concepts and levers across populations.
• Advise on payor and vendor contract terms and negotiations.
• Participation in overall strategic planning for the organization.
• Accountable for improvement in clinical documentation accuracy through oversite of the risk adjustment team, including accountability for:
• Ensuring clinical documentation and integrity efforts are in place for the accurate and complete reporting of Risk Adjustment Factor (RAF) scores.
• Driving system-wide RAF audits ensuring organization compliance with all applicable laws, rules, and regulations.
• Ensuring accurate measurement and reporting of clinical quality metric scores to ensure appropriate clinical care and revenue in all lines of business.
• Supporting education of providers on documentation model specifications and changes, and on the importance of clinical documentation both for clinical quality and financial performance across the Medicare, Medicare Advantage, and Exchange populations.
• Driving engagement of providers with coding tools and documentation actions.
• Driving productivity and efficiency in our coding education, post-visit, and pre-visit coding functions.
• Overseeing coding vendor relationships and driving improvements with such vendors.
• Driving submission of supplemental files for diagnosis capture.
• Forecasting Risk Adjustment Scores and the associated financial impacts and educating all necessary parties on those impacts.

KNOWLEDGE AND SKILLS REQUIRED:

• Five or more years’ experience in strategic and operational financial roles, including experience as the financial leader of a value-based care organization.
• A robust understanding of the following contract types and programs: Medicare Advantage, ACA Exchange, Commercial, ACO REACH, MSSP, Direct-to-Employer, and Bundles
• Ability to develop financial models in support of healthcare products, novel forms of provider payment including capitation, pay-for-performance, shared savings and similar incentive programs.
• Strong teamwork, interpersonal relations, communication, negotiation, and analytical skills.
• An in-depth understanding of health care financing and the health insurance industry.
• Broad experience in understanding, monitoring and managing complex business processes.
• Adept at developing and implementing administrative systems to ensure timely and accurate completion of diverse business procedures.
• The ability to understand health insurance and develop policies to ensure compliance.
• An understanding of the broad healthcare landscape, including provider, payor, and enablement company financial drivers.
• Understanding and experience designing and administering provider compensation programs.
• Experience interfacing with providers on compensation and financial drivers in value-based contracts.
• Ability to perform market financial research and strategic assessment around new business and growth opportunities.
• Understanding of the CMS-HCC and ACA risk models and associated financial implications.
• Ability to communicate complex financial concepts in an easy-to-understand manner, as well as pitch strategic opportunities with conviction.

KNOWLEDGE AND SKILLS PREFERRED :

• Experience with CMMI Government Programs
• Experience with Medicare Advantage
• Experience with Medicaid
• Experience with Commercial Pay for Performance arrangements

EDUCATION AND EXPERIENCE REQUIRED:

• Bachelor’s Degree in accounting or related finance field
• Minimum of 5 years’ experience in accounting and finance roles, including experience as the financial leader of a value-based care organization
• Experience in managing financial relationships between the payor and provider components of the health care system.
• The ability to communicate complex concepts in a clear, concise, and engaging manner

EDUCATION AND EXPERIENCE PREFERRED:

• Master’s degree

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

• CPA

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