Job description
#122500 Capitation Specialist - Hybrid/Remote
Filing Deadline: Thu 4/27/2023UC San Diego values equity, diversity, and inclusion. If you are interested in being part of our team, possess the needed licensure and certifications, and feel that you have most of the qualifications and/or transferable skills for a job opening, we strongly encourage you to apply.
For the safety and well-being of the entire university community, the University of California requires, with few exceptions, that all students, faculty and staff be vaccinated against the COVID-19 virus and influenza before they will be allowed on campus or in a facility or office. For more information visit: Flu Vaccine Mandate / COVID Vaccine Policy
UCSD Layoff from Career Appointment: Apply by 04/18/23 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.
Special Selection Applicants: Apply by 04/27/23. Eligible Special Selection clients should contact their Disability Counselor for assistance.
This position will work a onsite or hybrid schedule which includes a combination of working both onsite at Greenwich Drive and remote. (this is not a 100% remote position).
DESCRIPTION
Under direction of the Finance Manager, the Capitation Specialist is responsible for maintaining all administrative and technical aspects of the monthly capitation process. Responsible for retrieving, compiling and organizing the health plan capitation payment data for reporting, forecasting and trending purposes. Interacts with ETL team in preparation and completion of monthly capitation files into webcap timely. Reconcile the capitation reports against the health plan data files and payments to ensure accuracy. Prepares the capitation journals and submits to Finance for review and processing.
Conducts premium rate verification reviews to ensure accuracy of changes and increases to payor and provider contracts. Review reports against health plan data to ensure membership & capitation is reconciled. Provides information or reports to managers to be used in resource determination and allocation. Maintain proactive communication of project status issues and/or key findings with Manager and Cap Analyst as applicable. Provides administrative support to department colleagues and supervisor during critical time of need and/or with special projects as required.
MINIMUM QUALIFICATIONS
Two (2+) or more years of recent experience in a managed care or health plan administration environment.
Proven knowledge and understanding of managed healthcare operations. Ability totroubleshoot interface issues and determine first-level of errors of problems.
Experience coordinating with IT in the resolution of technical issues.
Highly proficient with MS Office Suite.
PREFERRED QUALIFICATIONS
Highly proficient with MS Office: Excel, Word, Outlook, Access, PowerPoint, etc.
Knowledge and understanding of managed healthcare operations.
Ability to troubleshoot interface issues and determine first level of errors or problems.
Experience coordinating with IT in the resolution of technical issues.
Experience with Epic system; Tapestry.
Familiar with UCSD systems, policies & procedures.
SPECIAL CONDITIONS
Must be able to work various hours and locations based on business needs.
Employment is subject to a criminal background check and pre-employment physical.
Pay Transparency Act
Annual Full Pay Range: $40,700 - $78,258 (will be prorated if the appointment percentage is less than 100%)
Hourly Equivalent: $19.49 - $37.48
Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).
Job offer is contingent on successful engagement in the UC COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).
If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands-on practice and in-person skills assessment; online-only certification is not acceptable.
UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and and dozens of outpatient clinics. We invite you to join our team!
Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.
To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.
UC San Diego Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity or sexual orientation. For the complete University of California nondiscrimination and affirmative action policy see: http://www-hr.ucsd.edu/saa/nondiscr.html
UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.
UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.
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