Overview
This role is with a multi-payor healthcare organization contracting with 15 health plans across the Southern California market. The organization generates over $2.5 billion in annual revenue and manages a monthly membership of more than 500,000 lives. The primary market focus includes the Inland Empire and San Diego regions, with collaboration across Los Angeles and Orange County markets.
The HMO business includes commercial, point of service, and Covered California (ACA) plans analyzed at the plan level. Medi-Cal is segmented into categories such as TANF, SPD, Dual, LIC, LTC and separated by Los Angeles, San Bernardino/Riverside, and Orange counties. The Medicare business involves understanding CMS bids, rebates, HCC, RAF scores, risk types, revenue definitions (Parts A & B), and payment integrity.
Contracts exist with health plans including Aetna, Anthem Blue Cross, Alignment, Blue Shield, IEHP, HealthNet, Humana, SCAN, UHC, Molina, Central, Sharp, Scripps, and AHMC. The Inland Empire and San Diego market is divided into three LCDOs: EPIC, NAMM, and San Diego.
Team goals focus on developing and strengthening talent, driving system integration, and leading migration to CapRev to enable real-time data visibility across key partner teams such as Accounting, Payor Contracting, and FP&A. The team delivers accurate, comprehensive reporting while leveraging large, complex datasets and maintaining detailed data understanding.
Responsibilities
- Manage time effectively and work collaboratively within a team.
- Analyze complex data from multiple health plans related to capitation revenue, CMS ARC codes, payment methodologies, and various plan codes.
- Submit month-end data loads to Accounting by WD -6, including data analysis by health plan and product, reconciliation of membership, revenue, PMPM, remittances, cash, and SOX documentation for month-over-month analysis.
- Handle ad hoc requests and submit reports accurately and on time.
- Communicate effectively both verbally and in writing; present in meetings while working remotely.
- Support migration to CapRev and collaborate with multiple teams.
Requirements
- Bachelor's degree OR certification in Accounting, Finance, or IT related field.
- Minimum 5 years of healthcare experience.
- Expert proficiency in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint).
- Strong skills in Excel and ability to write basic SQL queries.
- Experience managing and analyzing capitation revenue with understanding of value-based care models and financial performance.
- Ability to meet month-end Accounting deadlines and communicate highlights clearly and concisely.
- Self-motivated, organized, and able to work autonomously.
- Excellent verbal and written communication skills.
- Ability to multi-task and perform well under pressure.
Preferred Qualifications
- Master's degree or certification in Accounting, Finance, or IT related field.
- Master of Business Administration (MBA).
- Advanced SQL skills.
- Experience working with large datasets.
- Strong analytical skills.
Compensation & Benefits
- Salary range: $60,200 to $107,400 annually based on full-time employment.
- Pay is influenced by factors including local labor markets, education, work experience, and certifications.
- Comprehensive benefits package including incentive and recognition programs, equity stock purchase, and 401k contribution (subject to eligibility).
Location
- This position is 100% fully remote within the U.S.
- Occasional travel (approximately 5%) may be required if located in Southern California.
Additional Information
- The organization complies with all applicable minimum wage laws.
- Employment consideration is given to qualified applicants with arrest and conviction records pursuant to the San Francisco Fair Chance Ordinance.
- Candidates must pass a drug test before beginning employment.
Application Deadline: The posting will remain open for a minimum of 2 business days or until a sufficient candidate pool is collected. The posting may close early due to volume of applicants.