MedPOINT Management · 1 month ago
Provider Payment Analyst
Los Angeles, CA
Full-time
Onsite
Mid Level
3+ years expMedPOINT Management is a company focused on healthcare financial management, and they are seeking a Provider Payment Analyst. This role involves leading the preparation and analysis of capitation payments and ensuring accurate reporting for multiple providers, while also identifying trends and potential process improvements.
Medical
Responsibilities
Processing, quality reviewing and issuing monthly capitation payments and eligibility data files
Ensuring the accuracy and timeliness of monthly Medicare HMO capitation and specialty capitation payments and eligibility reports
Resolving revenue, capitation, eligibility and other issues with CMS (Center for Medicare and Medicaid Services) and contracted providers
Maintaining capitation records, files and monitoring reports to ensure accuracy of payment and compliance with contractual and regulatory requirements
Working with Provider Network Operations and Information Technology Department to identify and implement system corrections and enhancements to ensure payments are issued in line with contracted timing and rates
Drilling down to identify capitation and revenue trends and resolve issues/errors
Performs research on industry performance measures for evaluation of client performance
Prepare and submit any additional requested reports to IPA clients and their contracted capitated providers
Provides up to date review of capitation rate table configurations errors or concerns
Prepare capitation or other ad-hoc financial analysis as requested by the Senior Finance Manager, VP of Finance and Corporate Controller, CFO and/or the client
Prepare NACHA files and/or print checks for capitated providers and ensure correct delivery of payment timely
Collaborating with other analysts on finance projects (e.g. developing forecast and budget models, performing trend and cost-benefit analyses, etc.)
Qualification
Required
Bachelor's degree or an equivalent combination of education, training and experience is required
3+ years of Physician Organization or Health Plan, Hospital Finance and/or Health Plan experience
Definitive understanding of provider or specialty capitation process, medical terminology and standard industry reimbursement methodologies required
Demonstrates intermediate to advanced understanding and experience using Excel (VBA's, macros. Pivot tables, vlookup, hlookup), MS Access and other Microsoft Office Systems required
Ability to communicate clearly and effectively, work accurately, meet deadlines and provide effective reporting is required
Excellent interpersonal skills required to develop and maintain effective working relationships across all levels within the organization
Ability to work both independently and as part of a team
Willingness to ensure the job is performed within specified parameters and deadlines is essential
Crystal/SQL knowledge and experience necessary
Medi-Cal/Medicare/MHC knowledge is a must
Ensures accuracy and timeliness for capitation and specialty capitation deadlines
Must work effectively in a team environment and able a supportive contributor or leader in team matters. Must conduct him or herself professionally and be capable of developing and maintaining positive, service oriented relationships with all levels of healthcare professionals, both internal and external
Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Performs additional duties as assigned
Regular and reliable attendance is an essential function of the position
Work is normally performed in a typical interior/office work environment
No or very limited physical effort required. No or very limited exposure to physical risk
Preferred
Experience in and knowledge of CPT, HCPC, DRG, ICD-9, ICD-10 and NDC coding is a plus
Knowledge of CAPCheck and Ez-cap6 is a plus
Company
MedPOINT Management
MedPoint Management is a medical practice offering IPA management services.
501-1000 employees
H1B Sponsorship
MedPOINT Management has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (5)
2024 (2)
2023 (2)
2021 (9)
2020 (2)
Funding
Current Stage
Late StageLeadership Team
Kimberly Carey
President
Recent News
2025-09-25
Company data provided by crunchbase