Capitation Analyst III

Sutter Health • Sacramento, CA

10d • $50 - $75

About The Position

Ensures the organization receives and pays accurate capitation payments for all eligible members by reconciling payments to contracted rates and maintaining compliance with Health Plan (HP) agreements and regulatory requirements. Analyzes and interprets financial performance across multiple HMO products, extracting and synthesizing data from various sources to identify risks, trends, and opportunities. Provides robust reporting, advanced analytics, and actionable insights to internal and external stakeholders. This position supports Managed Care Finance (MCF) with responsibility for complex financial analysis and internal reviews of capitation. We are seeking a candidate with a strong healthcare finance foundation and solid understanding of provider reimbursement principles—such as risk adjustment, capitation, and fee-for-service—who can apply this expertise to advanced financial and operational analyses. The ideal candidate is highly analytical, detail-oriented, and comfortable working with large datasets. Strong Excel skills are required, and experience with Epic or SQL is preferred. Familiarity with capitation and managed care is highly desirable. This position partners closely with Finance leadership to validate capitation data, communicate insights, and explain the financial drivers behind capitation revenue through effective reporting and data visualizations. The successful candidate works independently, takes initiative, and can translate complex analysis and findings into actionable recommendations.

Requirements

• Bachelor's in Finance, Accounting, Business or related field
• 5 years recent relevant experience
• In-depth working knowledge of accounting and/or finance
• In-depth working knowledge of financial analysis and reporting methodologies
• In-depth working knowledge of data warehousing and relational database systems
• Knowledge of basic accounting principles, including generally accepted accounting principles (GAAP)
• Knowledge of policies, practices and procedures
• Familiarity with performance metrics and ability to meet identified targets
• General understanding of Enterprise Resource Planning (ERP) systems enabling technologies (e.g. contact center technologies) is beneficial
• Ability to learn new applications/software systems effectively and efficiently
• Ability to translate data analysis into suitable reports for presentation
• Ability to perform data analysis on complex data sets
• Strong analytical and problem-solving skills
• Excellent project management, planning, and forecasting skills
• Ability to provide constructive feedback to team members to support continuous improvement
• Ability to process requests consistently with high level of accuracy
• Ability to work with, train and coach other team members
• Ability to prioritize problems and promptly resolve or escalate when necessary
• Strong interpersonal skills with the ability to work with and collaborate
• Strong communication skills and have the ability to train others
• Strong time management skills and ability to manage individual assignments and complete duties within tight deadlines
• Demonstrated leadership skills and the ability to provide constructive feedback to team members to support continuous improvement
• Ability to communicate ideas both verbally and written to influence others using one-on-one contact, formal presentations, and group discussions
• Ability to recognize the appropriate style, level of detail, and message for the audience
• Effective internal consulting skills along with the ability to positively influence others in a desired direction to achieve identified outcomes without direct lines of authority
• Requires the ability to work with and maintain confidential information

Nice To Haves

• Familiarity with Office of Statewide Health Planning and Development (OSHPD) Chart of Accounts is preferred
• Strong Excel skills are required, and experience with Epic or SQL is preferred.
• Familiarity with capitation and managed care is highly desirable.

Responsibilities

• Review and reconcile monthly capitation summary reports; manage historical payment data for analysis, trending, and benchmarking.
• Validate carve-outs and other financial terms in capitation contracts, ensuring accurate setup in collaboration with Operations and MCF.
• Validate CMS Medicare Advantage and ACA risk scores, along with payer codes, for accuracy, consistency, and compliance.
• Develop and maintain SQL queries, automation tools, and advanced reporting to proactively identify anomalies and ensure data integrity across systems.
• Collaborate with Finance, IT, and Health Plan partners to resolve issues, standardize data, and improve process efficiency.
• Lead data and analytical projects from concept to completion, mentoring junior analysts and strengthening team capability.
• Calculate surplus and deficit settlement amounts for risk-sharing arrangements.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees