27 days old

Capitation Analyst III - Full Time, Days

Prospect Medical Systems - CA
Orange, CA 92866
  • Job Code
Capitation Analyst III - Full Time, Days

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

Capitation 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

Job Responsibilities/Duties

  • 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.


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.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol. Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm. For this reason, we require applicants to pass a screening for drug use as a condition of employment. This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit http://pmh.com/careers/ and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

EEOC is the Law: https://www1.eeoc.gov/employers/poster.cfm

Posted: 2022-04-23 Expires: 2022-05-22
Sponsored by:
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Capitation Analyst III - Full Time, Days

Prospect Medical Systems - CA
Orange, CA 92866

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