Health Plan Capitation Analyst

Astrana Health•Alhambra, CA

2d•$26 - $33•Remote

About The Position

We are currently seeking a highly motivated Health Plan Capitation Analyst. This role will report to the Manager - IPA Revenue Cycle Management and enable us to continue to scale in the healthcare industry.

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

Nice To Haves

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

Responsibilities

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