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Sutter Health · 4 days ago

Capitation Analyst III

Sacramento, CA

Full-time

Onsite

Senior Level

$50.16/hr - $75.24/hr

5+ years exp

Sutter Health is a healthcare organization, and they are seeking a Capitation Analyst III to ensure accurate capitation payments and compliance with Health Plan agreements. The role involves financial analysis, reporting, and collaboration with various stakeholders to provide insights into capitation revenue.

Health CareHospitalNon Profit

Comp. & Benefits

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

Qualification

Healthcare finance knowledgeFinancial analysisSQL proficiencyData warehousingExcel skillsAnalytical skillsProject managementInterpersonal skillsCommunication skillsTime managementLeadership skills

Required

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

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