Senior Manager, Medi-Cal Revenue

Salary Range:  $117,509.00 (Min.) - $152,762.00 (Mid.) - $188,015.00 (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 Senior Manager of Medi-Cal Revenue is responsible for maximize the team's efficiency, productivity and performance through development & implementation of Policy and Procedures.  The Senior Manager will oversee and direct Medi-Cal Revenue and Payments in excess of from the Department of Health Care Services (DHCS) to L.A. Care $1.2 million monthly membership or 43% of total L.A. Care enrollment. The Senior Manager develops strategies, implements, establishes internal controls, coordinates payments and ensures that contractual obligations are met within DHCS, Senate bills, fiscal programs and Plan Partner Service agreements. The Senior Manager will provide staff guidance on the processing and accuracy of the supplemental billing, submission process, sub-capitation contract, journal entry preparation, account analysis, month-end reconciliations and preparation of the financial reporting.  The Senior Manager will communicate, direct, review, and approve ad hoc reports, coordinate and oversee supporting audit schedules preparation and work with Information Technology to implement process improvement.  The Senior Manager will coordinate across the organization and serve as unit subject matter expert with multiple departments. The Senior Manager will report and communicate to the Director of Revenue Premium and Recovery Billing abnormalities, conduct root cause analysis, recommend solutions and implementation plans.  Manages all aspects of running an efficient  team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.  The Senior Manager will develop and coordinate training curriculum, mentor and coach new and existing staff on the Medi-Cal Revenue Plan Partners Lines of Business, process improvement and organizational changes.

Duties

Develops, directs, oversee systems implementation and business controls to monitor staff compliance; ensures staff are operating under all applicable standards. Ensures that the staff prepare accurate and timely analysis of the multiple contractual obligation driven from DHCS, senate bills, fiscal programs and Plan Partners service agreements; ensures the preparation of an accurate and timely supplemental billing and submission reconciled to Participating Physical Group (PPG), Plan partners and DHCS  validated by using predictive models, performance trends and cost benefit analysis. Ensures timely completion and submission of accurate Journal Entries and related General Ledger account analysis by reconciling revenues received from DHCS. Approves the revenue related financial activity tools for Medi-Cal line of business. 

 

Establishes and maintains administrative policies, procedures, processes, and standards for all registration, billing, and collections; ensures business policies and procedures are congruent with established Member Accounting practices and standards and aligned revenue cycle and operational/departmental objectives with overall strategic goals. Explore means of maximizing collections through the accurate and complete capture of all charges, oversee the establishment of an appropriate charge structure and charge rates consistent with industry standards and payer contracts. Supports L.A. Care's compliance program by verifying adherence to charge posting policies and procedures and ensures compliance with all applicable regulatory guidelines.

 

Manages complex projects, engaging and updating key stakeholders, developing timelines, leads others to complete deliverables on time and ensures implementation upon approval.  Plans and implements systems and procedures to maximize operating efficiency and achieve strategic priorities.  

 

Oversee daily processes associated with member accounting system and the electronic billing software. Collaborates with internal stakeholders and management to identify and implement system correction and enhancements. Maintain data integrity in the systems by communication to multiple departments the abnormalities, confirming accuracy of all systems and set up and conducting regulatory system review to ensure data accuracy.

 

Provide leadership, management, coaching and guidance to new and assigned staff for suc