Managed Care Analyst - Capitation Revenue

MemorialCare; Colonia Juarez (CA); Remote; USD 57,000 - 71,000; Full time

Job summary

MemorialCare is seeking a Managed Care Analyst - Capitation Revenue in Fountain Valley, CA (predominately remote; must reside in CA) to support contract modeling and financial analyses across system entities.

The role requires proficiency in SQL, EPIC, and advanced Excel, with responsibilities spanning ad hoc reporting, data integrity, and collaboration with the negotiation team to optimize capitation terms.

Qualifications

• 2 years experience in Managed Care analytics.
• Proficient in SQL development and Epic systems, with advanced Excel capabilities.
• Strong Microsoft Office skills.
• Highly organized with ability to meet deadlines.

Responsibilities

• Provide financial analysis and ad hoc reporting to internal stakeholders and leaders.
• Collaborate with senior team members and cross-functional departments to design and run queries and reports based on external reporting requests.
• Model specific reimbursement terms to support the Managed Care negotiation team.
• Develop and maintain reporting templates to measure performance of health plan trend and yield to proactive report out.
• Support monthly financial close by identifying trends and answering inquiries.

Skills

SQL development

Epic systems

Advanced Excel

Time management

Education

Bachelor’s degree in Business, Finance or Healthcare, required

Job description

Title: Managed Care Analyst - Capitation Revenue

Location: Fountain Valley, CA / Predominately Remote (Must be located in CA)

Department: Managed Care

Status: Full-Time

Shift: Days (8hr)

Pay Range*: $41.09/hr - $51.56/hr

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups – consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

The Managed Care Analyst advances MemorialCare’s Managed Care Contracting and Operational strategies through financial analysis, contract modeling, and advisory support. This role reports to the Manager of Managed Care Analytics and sits at the system level supporting all MHS entities: Hospitals, Foundation, IPA and Health Plan.

The position supports the Managed Care strategy by assembling and analyzing financial data for routine reports. Sources include but are not limited to: Snowflake, payor capitation data, cost accounting system data, GL, budgeting and patient billing data. Additionally, the Managed Care Analyst will evaluate complex commercial and government payer arrangements including ACOs, Direct to Employer, Medicare Advantage, Medi-Cal, medical group, and ambulatory contracts.

The Analyst will attain competency with: (1) Snowflake (2) SQL (3) Accounting systems (4) EPIC to analyze data and trends.

Essential Functions and Responsibilities of the Job

1. Provide financial analysis and ad hoc reporting to internal stakeholders and leaders.

2. Collaborate with senior team members and cross-functional departments to design and run queries and reports based on external reporting requests, ensuring data integrity, actuaries and timeliness.

3. Model specific reimbursement terms to support the Managed Care negotiation team, including MCMF, MHS, and MCSHP.

4. Depending on reporting area(s) assigned, some or all of the following:

   1. Develop and maintain reporting templates to measure performance of health plan trend and yield to proactivity report out on monthly basis.

   2. Support monthly financial close by proactively identifying trends, outliers, requested reports and answering inquiries

   3. Complete and distribute monthly reporting packages to internal stakeholders.

5. Applies strong analytical and problem-solving skills to evaluate complex data and business issues, leveraging both conventional and innovative approaches. Ability to work with minimal supervision, and take ownership of assigned analyses, deliverables, and issue resolution.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more... Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Minimum Requirements

Qualifications/Work Experience

• 2 years experience, preferably in Managed Care analytic setting.

• Proficient in SQL development and Epic systems, with advanced Excel capabilities, alongside strong command of Microsoft Office tools.

• Extremely organized with strong sense of priority, urgency and commitment to deadlines.

• Self-motivated individual able to handle fluctuating volumes of work , able to prioritize to meet deadlines.

Education/Licensure/Certification

• Bachelor’s degree in Business, Finance or Healthcare, required