Enrollment and Capitation Analyst

---

Job description

• Only qualified Enrollment and Capitation Analyst candidates located near the Oxnard, CA area to be considered due to the position requiring an onsite presence

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.

The position will assist in monitoring the eligibility loading process, running integrity reports, working with staff to resolve conflicting and rejecting data, they will also obtain revenue files and calculate and prepare client provider payments.

The Program Manager Revenue Integrity plays a vital role within the organization. The primary focus is upon insuring patient eligibility integrity and accurate revenue results for two client IPA's.

Required Qualifications:

Bachelor's Degree in a related field, Business, Accounting, Finance, health information management, or related field required

2+ years experience in eligibility and capitation management

Ability to demonstrate strong proficiency using MS Suite and other systems

Knowledgeable of accounting/revenue functions.

Strong analytical and problem-solving skills.

Ability to follow verbal and written instructions

Preferred Qualifications:

Knowledge of eligibility/insurance verification and managed care administration

MS SQL

Enrollment and Capitation Analyst Primary Responsibilities:

Monitors the daily operations of the department including all workflows, turnaround times, production levels, and staffing needs within budgetary and business planning guidelines

Compiles and analyzes monthly enrollment data to provide accurate enrollment schedules to various departments including Financial Analysis, Accounting, Provider Contracting, etc.

Prepare, analyze and monitor eligibility reconciliations to ensure that all exceptions and rejected data have been researched and updated

Assist and ensure that programming changes are requested, justified, and implemented properly for the business unit's eligibility manager software

Calculates and prepares client provider capitated payments monthly in line with contract timelines and requirements

Effectively and professionally communicate results, challenges and solutions through daily interaction and regular reports with management

Create and monitor standard reports to identify anomalies and/or trends impeding appropriate revenue capture. Act to identify issues and pursue payors to ensure correct payments are being made

Responds timely and effectively to requests from other departments as they relate to the functions of the Eligibility department

Manages revenue reconciliation by obtaining and monitoring daily revenue activity

Manage and train staff of four

Creates, analyzes, ad hoc reports to ensure all revenue is accounted for, and paid according to contract

Partners with finance to understand variances, and fluctuations in revenue received

Additional Details:

Training time is 100% in office

• Only those lawfully authorized to work in the designated country associated with the position will be considered.

• Please note that all Position start dates and duration are estimates and may be reduced or lengthened based upon a client's business needs and requirements.

Benefits:

For information and details on employment benefits offered with this position, please visit here . Should you have any questions/concerns, please contact our HR Department via our secure website .

California Pay Equity:

For information and details on pay equity laws in California, please visit the State of California Department of Industrial Relations' website here .

Rose International is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender (expression or identity), national origin, arrest and conviction records, disability, veteran status or any other characteristic protected by law. Positions located in San Francisco and Los Angeles, California will be administered in accordance with their respective Fair Chance Ordinances.

If you need assistance in completing this application, or during any phase of the application, interview, hiring, or employment process, whether due to a disability or otherwise, please contact our HR Department .

Rose International has an official agreement (ID ), effective June 30, 2008, with the U.S. Department of Homeland Security, U.S. Citizenship and Immigration Services, Employment Verification Program (E-Verify). (Posting required by OCGA 13/10-91.).

<!– job description page –>