- 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.
-
Financial Analyst Iii
1 day ago
CalOptima Orange, United States**Financial Analyst III** · **CalOptima** · **CalOptima Health** is seeking a highly motivated an experienced **Financial Analyst III** to join our team. The Financial Analyst III will be responsible for providing quantitative financial analysis for various departments within Cal ...
-
Business Analyst Iii
13 hours ago
Business Integra Inc Los Angeles, United States**Position: Business Analyst III - Appeals & Grievances** · **Location: Los Angeles, CA REMOTE** · **Duties**: · - Collaborat**e with stakeholders to understand business objectives and requirements · - Conduct data analysis using SQL and R to provide insights for decision-making ...
-
Financial Analyst Iii
4 days ago
Children's Hospital Los Angeles Los Angeles, United StatesLocation/Org Data : Introduction: · **NATIONAL LEADERS IN PEDIATRIC CARE** · Ranked among the top 10 pediatric hospitals in the nation, Children's Hospital Los Angeles (CHLA) provides the best care for kids in California. · Here world-class experts in medicine, education and rese ...
-
Capitation Analyst III
1 week ago
Alta Hospitals Orange, United StatesCapitation 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 da ...
-
Systems Analyst Iii
1 week ago
Paladin Technologies Los Angeles, United StatesAt Paladin Technologies Inc. we have a technology team serving our enterprise clients' physical security and audio video needs. The Systems Analyst will be responsible for delivering and maintaining the IT infrastructure that supports these platforms. · **RESPONSIBILITIES**: · - ...
-
Business Analyst Iii
13 hours ago
Mavinsys LLC Los Angeles, United States**Job Summary** · **Duties** · Develop functional and user acceptance test plans and scenarios. Coordinate functional and user acceptance testing by executing the testing strategy, scheduling resources and tracking test performance. Perform data analysis to support evaluation of ...
-
IT Business Systems Analyst Iii
1 week ago
County of Riverside Riverside, United StatesThe Riverside County Information Technology department has an opportunity for an IT Business Systems Analyst (BSA) III. The position is assigned to the Medical Center located in Moreno Valley. · The duties of a Business Systems Analyst III encompasses a diverse set of responsibil ...
-
Clinical Data Analyst Iii
1 week ago
L.A. Care Health Plan Los Angeles, United StatesClinical Data Analyst III · **Job Category**:Clinical**Department**:Quality Improvement**Location**:Los Angeles, CA, US, 90017**Position Type**:Full Time**Requisition ID**:11152**Salary Range**: $88, Min.) - $115, Mid.) - $142, Max.)- Established in 1997, L.A. Care Health Plan is ...
-
IT Business Systems Analyst Iii
13 hours ago
County of Riverside Riverside, United StatesThe Riverside University Health System (RUHS) has an opportunity for an IT Business Systems Analyst III supporting the Applications Division Team. · The Business Systems Analyst will be responsible for participating in research and development of new technologies to enhance and i ...
-
Health Program Analyst Iii
2 days ago
Los Angeles County Department of Human Resources Los Angeles County, CA, United States**TYPE OF RECRUITMENT**: · - Open Competitive Job Opportunity · **EXAM NUMBER**: · - PH4731G · **FIRST DATE OF DATE**: · Monday, April 29, 2024 from 12:00 p.m. to 1:59 p.m. Pacific Time (PT) · **No out-of-class experience will be accepted.** · **DEFINITION**: · Supervises a team ...
-
Revenue Financial Analyst Iii
1 week ago
Business Integra Inc Los Angeles, United States**Position: Revenue Financial Analyst III** · **Location: REMOTE** · **Duration: 26 Weeks** · **Job Summary**: · The Revenue Financial Analyst III is responsible for the daily management of financial activity of the Revenue received by L.A. Care. These duties includes revenue rec ...
-
Compliance Technical Analyst Iii
6 days ago
Inland Empire Health Plan Rancho Cucamonga, United States**What you can expect** · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an **authentic experience** · **Perks** · IEHP is not only committed to healing and inspiring the human sp ...
-
Business Systems Analyst Iii
6 days ago
UCLA Health Los Angeles, United States**Description** · Under general supervision of the Project Policy Analyst 3, the incumbent will develop solutions which may involve process design, data and information architecture, software development and policy or procedural changes, creation of specifications for systems to ...
-
Data Systems Analyst Iii
1 week ago
UCLA Health Los Angeles, United States**Description** · The Semel Institute for Neuroscience and Human Behavior is seeking to hire a full-time Data Sytems Analyst to join the Neuromodulation Division. In this role, you will be integral to optimizing lab protocols, ensuring consistency, and enhancing the overall user ...
-
Analyst III
1 week ago
Inland Empire Health Plans Rancho Cucamonga, United StatesWhat you can expect · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an · authentic experience · The Analyst III – Compliance Program has expert knowledge and performs key Compli ...
-
Analyst III
1 day ago
IEHP Rancho Cucamonga, United StatesWhat you can expect · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience · The Analyst III - Compliance Program has expert knowledge and performs key Complianc ...
-
Analyst III
4 days ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · What you can expect · Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience · The Analyst III Compliance Program has expert knowledge and performs key ...
-
Analyst III
1 week ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · What you can expect · Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience · The Analyst III Compliance Program has expert knowledge and performs key ...
-
Analyst III
4 days ago
IEHP Rancho Cucamonga, United StatesWhat you can expect · Find joy in serving others with IEHP We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience · The Analyst III - Compliance Program has expert knowledge and performs key Complia ...
-
Analyst III
2 days ago
Inland Empire Health Plan Rancho Cucamonga, United StatesOverview: · What you can expect · Find joy in serving others with IEHP We welcome you to join us in healing and inspiring the human spirit and to pivot from a job opportunity to an authentic experience · This position is responsible for providing actuarial analytic support to ...
Capitation Analyst III - Orange, United States - Prospect Medical Holdings
Description
Job DescriptionCapitation 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
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.
