Salary Range:  $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (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 in five health plans, 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 Supervisor, Medical Payment Processing is responsible  for supervising the daily adjudicated QNXT Claims, process and paid in SAP, ancillaries, providers’ incentives, Prop 56 Developmental Screening, Family Planning, Physician Services, Trauma Screening, Value Based payment, Hyde Services,  GEMT (Ground Emergency Medical Transportation), Members & Providers' refunds, all other providers’ invoices and capitation for all lines of business (LOB), MCLA (Medical Direct LA Care), DHS (Department of Health Services), LA Care Covered (LACC), L.A. Care Covered Direct (LACCD), PASC (Personal Assistance Services Counsel) & DSNP (Dual Special Needs Plan),  Community Health Worker incentives, Enhanced Care Management, and Homeless and Housing Sustaining Services. Responsibilities include review of daily invoice uploads; audit for accuracy of posted refunds and adjustment memos; reconcile of weekly cash requirements by analyzing historical trends; adhere to cash disbursement limits set by Treasury, ensuring cash projections needs are consistent and complete; communicate to management any differences between cash needs and cash usage reflecting accurately on the cash flow statement; and reconcile both QNXT to SAP general ledger.

 

The position is responsible for the month end process, and communicating the accruals related to these processes. The position is responsible for the coordination of multiple check writing systems. The position will ensure that it adheres to the Generally Accepted Accounting Principles (GAAP), maintain and monitor closely the internal controls. The position will interact with multiple departments, such as, Claims, Information Technology (I.T.), Facilities Management and Quality Improvement.

 

The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports to enable them to master the QNXT, SAP, and other required databases to ensure accuracy in the produced product.

Duties

Supervise staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.

 

Responsible for reviewing and approving the daily payment, line level reconciliation between SAP, QNXT and Zelis to ensure accurate processing.  Audit the provider Electric Funds Transfer (EFT) data by working with a third party vendor.  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.

 

Oversee and review the daily cash disbursement journals for accuracy. Ensure internal controls are current and adhered by staff.  Responsible for the reconciliation of weekly cash requirements and ensure timely completion and distribution to the appropriate staff.  

 

Responsible for the resolution of Provider and Member payment issues, month end close for all Lines of Business (LOBs) and Multiple systems including accruals.

 

Communicate and coordinate the payment process from multiple systems.

 

Review and update training manuals, policies, and procedures.

 

Prepare and report all 1099s in accordance with the IRS regulations.

 

Coordinate and supervise the vendor Levy Payments to IRS with Accounts Payable (AP).

Perform other duties as assigned.

Duties Continued

Education Required

Bachelor's DegreeIn lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Master's Degree in Finance

Experience

Required:

Minimum of 4 years of Accounts Payable experience with 1 year of experience in leading processes with enterprise resource planning systems (SAP and/or QNXT), automation, programs or staff, or as supervisor.

 

Experience in a fast-paced office setting with famil