Health Plan Capitation Analyst
Job Description:
• Prepare monthly, quarterly, and annual PCP and Specialist payments, ensuring that payments are accurate and timely
• Compile capitation payment data for analysis, forecasting and trending
• Identify drivers for unexpected variances and report findings to leadership
• Maintain data integrity of capitation payments by performing ongoing testing, validation and monitoring revenue data for PCP/Specialist payments and health plan capitation
• Review and analyze capitation relative to eligibility, providers and expense
• Work with health plans and internal organizations to resolve discrepancies and issues
• Develop and maintain routine and ad-hoc reports for the MSO Finance Dept and Providers
• Provide analysis reports to various internal departments to support business operations, various audits and objectives
• Review government healthcare policy directives and collaborate with team for implementation
• Review monthly capitation flux reports and research capitation variance across all IPAs
• Prepare Maternity Kick AR schedule, keep track of deliveries’ payments status, follow up with Health Plans on unpaid cases, work with hospital partners to reconcile and submit cases list to HPs on monthly basis
• Identify any capitation rate change across all IPAs on monthly basis and verify with the corresponding contracts
• Prepare Profit & Loss report for various criteria per request
• Other duties as assigned
Requirements:
• Bachelor's degree
• 1+ years’ experience in project management, operations, or related fields
• Ability to independently pursue and develop solutions to complex problems
• Effective communication skills
• Extensive experience with Microsoft Office Suite (Word, PowerPoint, Excel)
• Scrappy, eager, positive team player with no ego
• Strong comfort with working in a fast-paced environment
• An authentic passion for improving the lives of underserved patients and advancing value-based care
• Experience working on multiple complex projects end-to-end
• Previous work in capitation analysis, healthcare accounting, or equivalent skillset
• Familiarity with SQL, EZCap a plus
Benefits:
• This position is remotely based in the U.S. The office is located at 1668 S Garfield Avenue, Alhambra, CA 91801.
• The national target pay range for this role is between $25.71 - $32.99 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
• Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer.
• We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need.
• If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
• The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
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• Prepare monthly, quarterly, and annual PCP and Specialist payments, ensuring that payments are accurate and timely
• Compile capitation payment data for analysis, forecasting and trending
• Identify drivers for unexpected variances and report findings to leadership
• Maintain data integrity of capitation payments by performing ongoing testing, validation and monitoring revenue data for PCP/Specialist payments and health plan capitation
• Review and analyze capitation relative to eligibility, providers and expense
• Work with health plans and internal organizations to resolve discrepancies and issues
• Develop and maintain routine and ad-hoc reports for the MSO Finance Dept and Providers
• Provide analysis reports to various internal departments to support business operations, various audits and objectives
• Review government healthcare policy directives and collaborate with team for implementation
• Review monthly capitation flux reports and research capitation variance across all IPAs
• Prepare Maternity Kick AR schedule, keep track of deliveries’ payments status, follow up with Health Plans on unpaid cases, work with hospital partners to reconcile and submit cases list to HPs on monthly basis
• Identify any capitation rate change across all IPAs on monthly basis and verify with the corresponding contracts
• Prepare Profit & Loss report for various criteria per request
• Other duties as assigned
Requirements:
• Bachelor's degree
• 1+ years’ experience in project management, operations, or related fields
• Ability to independently pursue and develop solutions to complex problems
• Effective communication skills
• Extensive experience with Microsoft Office Suite (Word, PowerPoint, Excel)
• Scrappy, eager, positive team player with no ego
• Strong comfort with working in a fast-paced environment
• An authentic passion for improving the lives of underserved patients and advancing value-based care
• Experience working on multiple complex projects end-to-end
• Previous work in capitation analysis, healthcare accounting, or equivalent skillset
• Familiarity with SQL, EZCap a plus
Benefits:
• This position is remotely based in the U.S. The office is located at 1668 S Garfield Avenue, Alhambra, CA 91801.
• The national target pay range for this role is between $25.71 - $32.99 per hour. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
• Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer.
• We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need.
• If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
• The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Apply tot his job
Apply To this Job