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Capitation Specialist Jobs (NOW HIRING)

Prisma Health

Account Specialist F/T Day

Greenville, SC · On-site

$13.75 - $18.75/hr

Research and resolves claim and capitation problems. * Maintains timely provider information in physician files. * Maintains insurance company manual and distributes information to staff on updates ...

Prisma Health

Account Specialist F/T Day

Greenville, SC · On-site

Research and resolves claim and capitation problems. * Maintains timely provider information in physician files. * Maintains insurance company manual and distributes information to staff on updates ...

Nutex Health

IT Systems & API Integration Manager

IT Systems & API Integration Manager The purpose of the IT Systems & API Integration Specialist is ... Knowledge of claims processing, eligibility, provider data, and capitation workflows * Experience ...

EnableComp

Revenue Specialist, Denials

Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims ... Revenue Specialist "I enjoy working for EnableComp because of the Core Values we believe in.

EnableComp

Revenue Specialist, Denials

Franklin, TN · On-site

Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims ... Revenue Specialist "I enjoy working for EnableComp because of the Core Values we believe in.

New

EnableComp

Revenue Specialist, Denials

Franklin, TN · Remote

Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims ... Revenue Specialist "I enjoy working for EnableComp because of the Core Values we believe in.

New

EnableComp

Revenue Specialist, Denials

OR · On-site +1

Familiarity with HMO, PPO, IPA, and capitation terms and how these payors process claims ... Revenue Specialist "I enjoy working for EnableComp because of the Core Values we believe in.

Imagine Pediatrics

Medical Coding & Billing Specialist

OR · On-site +1

$18.75 - $24/hr

What You'll Do As a Medical Billing & Coding Specialist, you'll serve in a hybrid role that blends ... Experience with telehealth billing, value-based care, capitation models, and quality measures a ...

Imagine Pediatrics

Coding & Billing Specialist

OR · On-site +1

$18.75 - $24/hr

What You'll Do As a Medical Billing & Coding Specialist, you'll serve in a hybrid role that blends ... Experience with telehealth billing, value-based care, capitation models, and quality measures a ...

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All JobsCapitation Specialist Jobs

Capitation Specialist information

See salary details

$31.5K

$69.7K

$133K

How much do capitation specialist jobs pay per year?

As of Sep 6, 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.

More about Capitation Specialist jobs

What cities are hiring for Capitation Specialist jobs?

Cities with the most Capitation Specialist job openings:

What states have the most Capitation Specialist jobs?

States with the most job openings for Capitation Specialist jobs include:

What job categories do people searching Capitation Specialist jobs look for?

The top searched job categories for Capitation Specialist jobs are:

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.

Account Specialist F/T Day

Prisma Health

Greenville, SC • On-site

$13.75 - $18.75/hr

Full-time

Re-posted 7 days ago

Prisma Health rating

7.1

Company rating: 7.1 out of 10

Based on 351 frontline employees who took The Breakroom Quiz

379th of 898 rated healthcare providers

Job description

Inspire health. Serve with compassion. Be the difference.
Job Summary
Responsible for processing insurance claims. Coordinates collections and delinquent unpaid accounts. Oversees claim processing. Investigates billing problems and assists with error resolution.
Essential Functions
  • All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
  • Assists in the processing of insurance claims including Medicaid/Medicare claims.
  • Collects and enters patient's insurance information into database.
  • Assists patients in completing all necessary forms. Answers patient questions and concerns.
  • Reviews and verifies insurance claims. Requests refunds when appropriate.
  • Processes Medicare correspondence, signature, and insurance forms.
  • Follows-up with insurance companies and ensures claims are paid within timeframes as outlined in MA policies and procedures.
  • Resubmits insurance claims that have received no response.
  • Answers telephone, screens call, takes messages, and provides information.
  • Maintains files with referral slips, Medicare authorizations, and insurance slips.
  • Identifies delinquent accounts, aging period and payment sources. Processes delinquent unpaid accounts by contacting patients and third party reimbursors.
  • Reviews each account, credit reports and other information sources such as credit bureaus via computer.
  • Performs various collection actions including contacting patients by phone and resubmitting claims to third party reimbursors.
  • Evaluates patient financial status and establishes budget payment plans. Follows and reports status of delinquent accounts.
  • Reviews accounts for possible assignment makes recommendation to Credit Manager and prepares information for collection agency.
  • Assigns uncollectible accounts to collection agency or attorney via clinic Credit and Collection policy. Contacts lawyers involved in third-party litigation.
  • Answers inquiries and correspondence from patients and insurance companies. Develops collection letters.
  • Identifies and resolves patient billing complaints. Research credit balances.
  • Oversees claim processing and payments to third party providers. Answers associated correspondence.
  • Monitors charges and verifies correct payment of claims and capitation deductions.
  • Sends denial letters on claims and follow-up on requests for information.
  • Audits and reviews claim payments reports for accuracy and compliance.
  • Research and resolves claim and capitation problems.
  • Maintains timely provider information in physician files.
  • Maintains insurance company manual and distributes information to staff on updates and changes.
  • Maintains required databases and patients accounts, reports and files.
  • Resolves misdirected payments and returns incorrect payments to sender.
  • Answers patients' inquiries regarding account balances.
  • Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate.
  • Works all assigned claims within designated time frame to ensure timely and appropriate payment
  • Research all information needed to complete billing process including getting charge information from physicians.
  • Works with other staff to follow-up on accounts until zero balance or turned over for collection.
  • Assists with coding and error resolution.
  • Maintains required billing records, reports, and files.
  • Investigates billing problems and formulates solutions. Verifies and maintains adjustment records.
  • Maintains and enhances current knowledge of assigned payers with regard to guidelines for billing
  • Provides training to front office staff when hired and retraining as needed or requested with regard to a specific payer rules and guidelines for physician billing.
  • Recommends changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle.
  • Maintains strictest confidentiality.
  • Participates in educational activities.
  • As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual.
  • Performs other duties as assigned.

Supervisory/Management Responsibility
  • This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements
  • Education - High School diploma or equivalent OR post-high school diploma / highest degree earned. Associate degree in a technical specialty program of 18 months minimum in length preferred
  • Experience - Two (2) years in billing, bookkeeping, collections or customer service.

In Lieu Of
  • NA

Required Certifications, Registrations, Licenses
  • NA

Knowledge, Skills and Abilities
  • Electronic Claims Billing experience
  • Multi-specialty group practice setting experience preferred
  • Intermediate ICD-9 and CPT coding abilities preferred

Work Shift
Day (United States of America)
Location
Patewood Outpt Ctr/Med Offices
Facility
Pulmonology Lung Center
Department
Pulmonology Lung Center-Practice Operations
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.

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