Capitation Analyst II in Orange at Prospect Medical Systems

Date Posted: 10/30/2020

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    600 City Parkway West
    Orange
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
    10/30/2020
  • Job ID:
    16898

Job Description



Capitation Analyst II

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Capitation Analyst II works within the Decision Support Services (DSS) department to analyze PCP and Specialist capitation payment data and health plan revenue payment data within a managed care organization. The Capitation Analyst II is responsible for communicating and disseminating guidelines and documentation related to PCP/Specialist capitation or Health Plan Revenue, creating relevant reports, and evaluate potential recovery.



Job Responsibilities/Duties

  • Compiles and validates capitation payment data or health plan capitation data to ensure payments are timely and accurate. Identifies drivers of variances and presents findings to management and internal departments prior to monthly capitation payments.
  • Drills down to identify capitation trends and collaborates with other departments to communicate and validate unexpected variances and resolve issues involving capitation payments. Collaborates with internal departments to resolve capitation inquiries from contracted providers.
  • Maintains data integrity of PCP/Specialty capitation and health plan revenue capitation SQL databases. Performs on-going testing, validation, monitoring, and financial reporting of capitation module with continued efforts related to process improvement. Analyzes data for integrity between internal and external parties.
  • Develops and maintains routine and ad-hoc reports for internal review. Provides ad-hoc analysis requests from internal clients as required.
  • Performs and leads special projects as assigned.

Minimum Education: Bachelor's degree or equivalent education and experience in Finance or related field required. 

Minimum Experience:  Two to four (2-4) years of experience with capitation processing in an HMO managed services organization required. One to two (1-2) years of experience with financial analysis experience in the health care environment required. Requires understanding of general accounting/financial concepts. Requires working knowledge of Microsoft Excel. Requires strong critical thinking and analytical skills. Requires excellent communication skills with the ability to write business correspondence and effectively respond to question from all levels of the organization, including executive management, coworkers, and internal clients. Requires ability to work cooperatively as a team member to accomplish tasks and contribute to a positive work environment by treating everyone with professionalism and respect. Experience with Microsoft Access and SQL is required including database management, data extracts, queries, and report writing. Knowledge of healthcare industry, particularly in managed care is required.

Req. Certification/Licensure: NONE.



Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.



How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Keywords: Capitation, Analyst, DSS, PCP, Managed Care, Health Plans, Revenue, Reporting, data management, payments, SQL, Managed Care, Access, queries. Payment Policies, Audit, Current Performance, Claims, Acute Care



16898