Medical Payment Processing Coordinator II

Job Summary

The 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 LA Care regulatory policies and GAAP regulatory requirements.  

This position will work with various departments to coordinate payment cycles. Analyze and upload into SAP system, prepared 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 will complete 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 and Analyze 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  LA 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

Education Preferred

Experience

Required:
At least 2 year 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 environment

Preferred:
SQL experience

Skills

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

Additional Information