The Capitation Analyst I will work within the Decision Support Services (DSS) department and will work closely with the DSS Supervisor to develop expertise in the processes and components of PCP and Specialist capitation payments within a managed care organization, including membership, provider capitation rates, and line of business mix .
- Compiles and validates capitation payment data to ensure monthly capitation 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 evaluate trends and unexpected variances and resolve issues involving capitation payments.
- Maintains data integrity of capitation SQL database. 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.
- Collaborates with internal departments to resolve capitation inquiries from contracted providers.
- Develops and maintains routine and ad-hoc reports for internal review. Delivers on ad-hoc analysis requests from internal clients.
- Performs and leads special projects as assigned.
- 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 preferred including database management, data extracts, queries, and report writing.
- Knowledge of healthcare industry, particularly in managed care is preferred.