Manager of Provider Capitation

Job Summary

A company is looking for a Manager - Provider Capitation to oversee capitation payments and ensure financial integrity.

Key Responsibilities

• Manage monthly capitation payments to providers, ensuring accuracy and compliance with contract terms
• Reconcile member eligibility and enrollment data to validate payments
• Serve as the point person for SOX audits related to capitation processes

Required Qualifications

• Bachelor's degree in Finance, Accounting, Business, or related field; Master's preferred
• 5+ years of experience in managed care or healthcare finance, including capitation or provider reimbursement
• Strong knowledge of eligibility, capitation models, and SOX/internal control processes
• Proficient in Excel and data/reporting tools; experience with healthcare systems preferred