Capitation Analyst III

We are so glad you are interested in joining Sutter Health!

Organization :

SHSO-Sutter Health System Office-Valley

Position Overview :

Ensures the organization receives and pays accurate capitation payments for all eligible members by reconciling payments to contracted rates and maintaining compliance with Health Plan (HP) agreements and regulatory requirements. Analyzes and interprets financial performance across multiple HMO products, extracting and synthesizing data from various sources to identify risks, trends, and opportunities. Provides robust reporting, advanced analytics, and actionable insights to internal and external stakeholders.

Job Description :

This position supports Managed Care Finance (MCF) with responsibility for complex financial analysis and internal reviews of capitation. We are seeking a candidate with a strong healthcare finance foundation and solid understanding of provider reimbursement principles-such as risk adjustment, capitation, and fee-for-service-who can apply this expertise to advanced financial and operational analyses. The ideal candidate is highly analytical, detail-oriented, and comfortable working with large datasets. Strong Excel skills are required, and experience with Epic or SQL is preferred. Familiarity with capitation and managed care is highly desirable.

This position partners closely with Finance leadership to validate capitation data, communicate insights, and explain the financial drivers behind capitation revenue through effective reporting and data visualizations. The successful candidate works independently, takes initiative, and can translate complex analysis and findings into actionable recommendations.

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.

EDUCATION :

Equivalent experience will be accepted in lieu of the required degree or diploma.

Bachelor's in Finance, Accounting, Business or related field

TYPICAL EXPERIENCE :

• 5 years recent relevant experience,

SKILLS AND KNOWLEDGE :

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

Familiarity with Office of Statewide Health Planning and Development (OSHPD) Chart of Accounts is preferred

General understanding of Enterprise Resource Planning (ERP) systems enabling technologies (e.g. contact center technologies) is beneficial

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

Job Shift : Days

Schedule : Full Time

Days of the Week : Monday - Friday

Weekend Requirements :

Occasionally

Benefits : Yes

Unions : No

Position Status : Exempt

Weekly Hours : 40

Employee Status : Regular

Sutter Health is an equal opportunity employer EOE / M / F / Disability / Veterans.

Pay Range is $50.16 to $75.24 / hour. Utah Pay Range is $36.48 to $54.72 / hour. Arizona Pay Range is $36.48 to $54.72 / hour. Colorado Pay Range is $41.04 to $61.56 / hour.

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate's experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package. ?