Capitation Analyst III

4 weeks ago

Orange, United States Prospect Medical Holdings Full time
Job Description

Capitation Analyst III communicates and disseminates guidelines or documentation relating to Capitation payments for PCPs and Specialists. Creates reports and evaluates all potential recovery. Plan and set goals, in dynamic environment, for department goals. Analyze capitation data and research variances. Develop self, and maintain knowledge of managed care industry at all times

Responsibilities

  • Requires experience and extensive knowledge in each of the following areas: PCP Payments - Candidate needs to understand how PCP capitation payments are made. Specialist Capitation Payments - Needs to understand how payments are made and calculated; Specialist Capitation Payments - Needs to understand how payments are made and calculated; PCP Payments - Needs to understand payments for Managed Groups for all States; Capitation Payments - Needs to understand how payments are calculated.
  • Compiles and organizes capitation payments data for analysis, forecasting and trending purposes. Interprets key capitation data shifts and presents findings in a clear and concise manner in written, visual and/or oral fashion to Senior Analyst or Supervisor
  • Responsible for the monthly maintenance and data integrity of the capitation. On-going testing, validation, monitoring and financial reporting of the capitation module with continued efforts relating to processes improvement. Assures timely and accurate monthly capitation payments. Appropriate recommendations are required
  • Creates monthly, quarterly, and annual PCP and Specialist payments report for internal review. Develops new, routine and ad hoc reports for Providers and Finance Department for PCP and Specialist Capitation payments. Creates system documentation, including process flow and desk top procedures. Looks for ways to streamline reporting processes
  • Actively participate in supporting internal departments with analysis and reports. Mentors team by providing guidance, support, and assisting with escalated issues and tasks as needed
  • Other duties as assigned.


Qualifications

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

Minimum Experience: Four (4) plus Experience with capitation processing in an HMO managed services organization preferred. Two to Three (2-3) years financial analysis experience in the health care environment preferred.

Req. Certification/Licensure: None.

About Us

With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and wellness services. Each of our Independent Physician Associations (IPAs) and networks support the use of advanced diagnostic and treatment tools to provide our members with convenient access to state-of-the-art healthcare. For 25+ years, Prospect Medical has been focused on our mission of supporting independent physicians where, through risk arrangements, we work closely together with health plans, facilities and healthcare physicians for the benefit of every person who comes to us for care. We provide quality healthcare services that are designed to offer our patients highly coordinated, personalized care and that help them live healthier lives. Prospect Medical Systems manages highly successful IPAs by leveraging our best-practices, results-driven administrative services to manage patients under risk arrangements with health plans/CMS.

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