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Capitation Specialist Jobs (NOW HIRING)

Astrana Health Management

$124 - $145/hr

Director - Provider Contracting (Capitation Specialist) Department: Provider Contracting Employment Type: Full Time Location: 1600 Corporate Center Dr., Monterey Park, CA 91754 Reporting To: Dawn ...

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Physicians DataTrust

$85 - $125/hr

Provide support to providers with issues related to contracting, capitation, claims, referrals, and ... Maintain provider manuals for PCP and Specialists including in-service materials. * Provide ...

Blue Ridge Care

Medicaid Specialist

Winchester, VA · On-site

$20 - $25/hr

Medicaid Specialist - Blue Ridge Care Services Your expertise can open doors to care. Your guidance ... Communicate eligibility updates that may impact services or capitation. * Support process ...

Blue Ridge Care

Medicaid Specialist

Winchester, VA · On-site

$52 - $76/hr

Medicaid Specialist - Blue Ridge Care Services Your expertise can open doors to care. Your guidance ... Communicate eligibility updates that may impact services or capitation. * Support process ...

High Desert Medical Group

Staff Accountant

Lancaster, CA · On-site

$30.66 - $40.89/hr

Perform Specialist capitation functions - create check requests and supporting spreadsheets. * Other duties as assigned. The pay range for this position at commencement of employment is expected to ...

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All JobsCapitation Specialist Jobs

Capitation Specialist information

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$31.5K

$69.7K

$133K

How much do capitation specialist jobs pay per year?

As of Sep 2, 2026, the average yearly pay for capitation specialist in the United States is $69,738.00, according to ZipRecruiter salary data. Most workers in this role earn between $47,500.00 and $84,500.00 per year, depending on experience, location, and employer.

What is a capitation specialist?

Capitation Specialists are professionals responsible for managing and administering capitation payment systems within healthcare organizations. They ensure accurate processing of capitation payments to providers, monitor contract compliance, and reconcile payment discrepancies. Their work involves analyzing data, collaborating with providers and payers, and supporting the financial aspects of value-based care models. Capitation Specialists play a key role in helping organizations transition to and maintain risk-based reimbursement structures.

What are the key skills and qualifications needed to thrive as a capitation specialist?

To thrive as a Capitation Specialist, you need a solid understanding of healthcare finance, claims processing, and capitation contract management, often supported by a degree in business, healthcare administration, or a related field. Familiarity with medical billing software, data analytics tools, and systems like Excel or healthcare databases is typically required. Attention to detail, analytical thinking, and strong communication skills distinguish top performers in this role. These skills are crucial for accurately managing provider payments, ensuring compliance, and maintaining effective partnerships within healthcare organizations.

What are some common challenges faced by capitation specialists, and how can they be addressed?

Capitation Specialists often encounter challenges such as managing complex provider contracts, ensuring accuracy in capitation payments, and reconciling discrepancies in membership data. Effective communication with both internal teams and external partners is crucial, as is staying updated on regulatory changes and payer requirements. Utilizing robust data management tools and collaborating closely with finance and provider relations teams can help address these challenges and ensure smooth capitation processes.

What is the difference between Capitation Specialist vs Claims Analyst?

AspectCapitation SpecialistClaims Analyst
CredentialsTypically requires healthcare or insurance certifications, such as CPC or CPC-HOften requires similar certifications, with emphasis on claims processing and coding
Work EnvironmentWorks in healthcare insurance companies, provider organizations, or managed care settingsEmployed in insurance companies, healthcare providers, or third-party administrators
Industry UsageCommonly used in managed care, health plans, and insurance sectorsWidely used in insurance claims processing and healthcare reimbursement

Both roles involve healthcare insurance and require knowledge of medical coding and billing. While a Capitation Specialist focuses on managing capitated payments and risk adjustment, a Claims Analyst primarily reviews and processes insurance claims. They often work together within healthcare organizations but have distinct responsibilities related to healthcare reimbursement and financial management.

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Capitation Specialist jobs near you
Infographic showing various Capitation Specialist job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $69,738 per year, or $33.5 per hour.

Director - Provider Contracting (Capitation Specialist)

Astrana Health, Inc.

Monterey Park, CA • On-site

$124K - $145K/yr

Full-time

Posted 5 days ago

Job description

Director - Provider Contracting (Capitation Specialist)
Department: Provider Contracting
Employment Type: Full Time
Location: 1600 Corporate Center Dr., Monterey Park, CA 91754
Reporting To: Dawn Camou
Compensation: $124,000 - $145,000 / year
Description
Job Title: Senior Director - Provider Contracting
Department: Contracting
About the Role:
We are currently seeking a highly motivated Senior Director - Provider Contracting. This is a hybrid role where the expectation is to work both in office 2 to 3 days in Alhambra, CA and Monterey Park, CA and at home on a weekly basis.
This role will work closely with the VP of Contracting to develop and execute on managed care capitated specialist contracting strategies and negotiations. You will be responsible for identifying and evaluating specialist capitation provider opportunities, determining optimal reimbursement rates, drafting and managing contracts, serving as an organizational subject matter expert on existing capitation service agreements for Multi-State Market and other states, and researching and resolving payor and provider issues.
What You'll Do
  • Own and manage capitated specialist relationships with senior leadership, serving as the escalation point for critical issues and long-term partnership development.
  • Design and oversee contracting strategies aligned with organizational goals for growth, compliance, and cost-effectiveness.
  • Act as a thought leader, providing executive-level guidance on contracting initiatives.
  • Direct and ensure proper administration of Division of Financial Responsibility (DOFRs), contract amendments, and RFPs.
  • Oversee project management of all specialist capitation contracting initiatives, ensuring timely, compliant execution.
  • Interpret and assess contractual risk in provider agreements, leading high-stakes, time-sensitive negotiations.
  • Ensure contracts optimize reimbursement, protect the organizations' interests, and strengthen provider relationships.
  • Establish and maintain policies and processes that streamline contract review, approval, and execution across the enterprise.
  • Partner with Claims, Configuration, Business Development, and Data Management to align operations with contracting strategies.
  • Drive root-cause solutions to systemic issues affecting contract performance or compliance.
  • Provide executive-level reports and recommendations to senior leadership on network adequacy, financial impact, and strategic opportunities related to specialist capitation agreements.
  • Other duties as assigned.

Qualifications
  • Master's degree and/or Bachelor's degree (BS/BA) in business administration or a health care related field, or equivalent experience
  • Have at least 10 years of prior experience in capitation contracting with Specialists.

You're great for this role if:
  • You can analyse complex financial data, contracts, and regulatory documents with accuracy and insight.
  • You bring strong problem-solving skills and a strategic, methodical approach to delivering sustainable solutions.
  • You are highly organised, detail-focused, and effective at leading teams through thorough investigations with ambiguous or incomplete information.
  • You communicate clearly, verbally and in writing, and can translate technical and contractual language into practical recommendations for executives and stakeholders.
  • You have deep knowledge of delegated network operations and regulatory requirements, including overseeing compliance in complex healthcare settings.
  • You are highly proficient in Microsoft Excel, Word, and PowerPoint, using them for strategic presentations, contract modelling, and executive reporting.
  • You understand EZ-Cap and other proprietary healthcare administration systems and can lead teams that use these platforms effectively.

Environmental Job Requirements and Working Conditions
  • Our organization follows a hybrid work structure where the expectation is to work both in office and at home on a weekly basis. The office is located at 1600 Corporate Center Dr. Monterey Park, CA 91754 and 600 City Parkway West, Orange, CA 92868.
  • The annual total compensation target pay range for this role is: $124,000 - $145,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

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