Medical Payment Processing Coordinator II Job Category: Accounting/Finance Department: Medical Payment System & Services Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11847 Salary Range: $55,245.00 (Min.) - $69,045.00 (Mid.) - $82,867.00 (Max.)Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.Job Summary The Medical Payment Processing Coordinator II is responsible for ensuring all System Application and Products (SAP) provider claims, incentives, Capitation payments and Member out-of-pocket refunds for all Lines of Business (LOBS), MCLA, LACC, LACCD, PASC, CMC, and the Plan Partners, Anthem Blue Cross, Kaiser and CFTS Promise, are processed in accordance with L.A. Care regulatory policies and GAAP regulatory requirements. This position works with various departments to coordinate payment cycles. Analyze and upload into SAP system, prepare submitted documents, reconcile output of various data files to ensure payments and coding accuracy. Communicate discrepancies to appropriate departments, communicate processing errors and follow through resolution. This position completes daily payment related line level reconciliation between SAP, QNXT and Payspan. Create financial activity reports, the daily SAP/QNXT claims processed report, weekly cash flow trends, and perform the SAP/QNXT month end financial reconciliation between QNXT/SAP and document variances at the payment level. Duties Responsible for the cost of care check processing cycles by line of business (MCLA, LACC, LACCD, PASC, CMC and the Plan Partners, Anthem Blue Cross, Kaiser and CFTS Promise). Ensure all cost of care payments are produced accurately and timely including, mailing. This includes paper checks and (Electronic Funds Transfer) EFT. Responsible for the daily research and communication to Treasury for positive pay issues. (20%) Responsible for analyzing provider/member payment dispute through resolution to inquiring parties in a timely manner. Including but not limited to, performing check tracers, stop payments, voids, reissuing of checks, provide stop less adjustments to provider accounts on as needed basis. Assist in bank reconciliation by completing the stale dated workflow, prepare documentation for escheatment process. Results are provided to third party vendor, SOVOS. (15%) Validate documentation provided by (A&G) Appeals & Grievances Dept. for member reimbursement request to ensure all regulatory requirements are provided by A&G and meet L.A. Care compliance standards. Communicate corrections needed to appropriate departments for processing payments accurately and timely. Information sent to necessary dept., (EDI) Electronic Data Interchange Dept., (CGPM) Commercial and Group Product Management in their requested reporting method and format. (5%) Responsible for the preparation of all cash related documents. Prepare uploads to SAP core payment system with appropriate and various data fields, and reconcile output generated payment from core SAP systems. Reconcile SAP/QNXT/PAYSPAN daily and monthly reports as they pertain to the payment cycles. All reports are reconciled and distributed accurately and timely including positive pay and ACH file to the bank. Ensure all audit schedules are maintained for easy access upon request. (15%) Duties Continued Responsible for the coordination and accurate uploading of the multiple data files representing payment data into SAP. Analyze uploads completed by MPSS team members and validate at a line level, and communicate inconsistencies and reject incorrect data fields to the originator to correct the data. All input and output files reconciled in SAP. (15%) Validate and analyze technical jobs in core SAP system and communicate the pass and fail in timely manner. Communicate and interact with the Information Services Dept. when needed to resolve production challenges. Responsible for daily reconciliation between QNXT, SAP and PAYSPAN. Ensure all data is correct prior to processing payment. Retrieve all related reports from SAP to reconcile the payment interfaced with third party vendor (Payspan). (20%)All electronic files are maintained and categorized correctly. Proper data management is practiced so that all e-files can be easily accessed. All files are accessible and organized in a timely basis. (5%) Perform other duties as assigned.(5%)Education Required High School Diploma/or High School Equivalency CertificateEducation Preferred Associate's Degree in Business Administration or FinanceExperience Required:At least 2 years of experience in a fast-paced office setting with familiarity and proficiency with a computerized environment, particularly working with databases and producing reports. Accounts payable or Accounting experience in a health plan environmentPreferred:SQL experienceSkills Required:Excellent organizational skills.Demonstrated ability to work effectively in a team environment.Excellent verbal and written communication skills.Excellent computer skills, proficient knowledge of Microsoft excel and word. Ability to multitask. Excellent analytical skills with ability to pay attention to details.Preferred:SAP and QNXT knowledge a plus.Licenses/Certifications Required Licenses/Certifications Preferred Required Training Physical Requirements LightAdditional Information Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.L.A. Care offers a wide range of benefits including
Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)
