Capitation Analyst III at Sutter Health

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: Finance, Accounting, Economics, Business Administration or related field

TYPICAL EXPERIENCE:

5 years recent relevant experience

SKILLS AND KNOWLEDGE:

Working knowledge of accounting and financial operations and processes.
Knowledge of Generally Accepted Accounting Principles (GAAP).
Working knowledge of financial analysis principles, methods, practices, and procedures.
Working knowledge of financial modeling.
Working knowledge of computerized accounting/financial systems and how it’s used in compiling, recording, maintaining accounting/financial transactions and information.
Ability to translate complex financial data and analysis into reports and presentations for appropriate audience.
Ability to read, comprehend, interpret and apply policies, procedures, practices, and regulatory and legal requirements.
Ability to compute and apply basic mathematical functions and computations, including percentages, decimals and prorated amounts.
Critical thinking and analytical abilities.
Ability to work with large and complex data sets.
Organization skills and attention to details.
Displays a customer service focus in all decisions and actions.
Ability to prioritize workload to complete assignments accurately and timely, and to meet strict timelines.
Ability to communicate through verbal and written means.
Ability to interact and maintain effective working relationships with those contacted in the performance of required duties.
Demonstrates respect for cultural and linguistic differences and promotes an inclusive work environment.
Demonstrates initiative in providing feedback/input to improve workflow/processes.
Ability to work effectively in a dynamic and fast-paced environment with changing business priorities.
Ability to maintain and work discreetly with confidential information.
Ability to use essential applications and/or databases associated with the role’s duties and responsibilities.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

Days of the Week:

Monday - Friday

Weekend Requirements:

Occasionally

Benefits:

Yes

Unions:

Position Status:

Non-Exempt

Weekly Hours:

Employee Status:

Regular

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

Pay Range is $45.60 to $68.40 / 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.