Accounts Payable Specialist – Medicare

Responsibilities

• Manage complex payment operations in a regulated health plan environment.
• Support claims-related provider payments, monthly capitation payments to delegated IPAs, capitation deductions (cap deducts), broker/agency/agent commissions, and vendor disbursements.
• Own payment data accuracy, reconciliations, and assist with monthly close activities while ensuring compliance with CMS regulations, internal controls, audit standards, and the end-to-end 1099 process.
• Partner closely with Claims, Provider Finance, Network Operations, and Actuarial to ensure provider payment and capitation-related data integrity.
• Research and resolve provider payment, capitation, and cap deduct discrepancies.
• Process and reconcile broker, agency, and agent commission payments tied to Medicare Advantage enrollments.
• Maintain broker/agent master data, payment setup, and tax documentation.
• Support internal, external, and regulatory audits related to commission payments.
• Perform selected account reconciliations to ensure accuracy and resolve any discrepancies.
• Own the accuracy and completeness of provider, IPA, broker, and vendor payment data across AP and upstream systems.
• Investigate and escalate issues associated with invoices and communicate as appropriate.
• Maintain audit-ready support for CMS audits, internal audits, and financial audits.
• Assist and learn the end-to-end 1099 process, including vendor and provider classification, annual data validation, reconciliation, issuance, and correction filings.
• Serve as the primary point of contact for 1099 questions from vendors, providers, brokers, and internal stakeholders.
• Reconcile the AP sub-ledger to the general ledger and resolve discrepancies on a monthly basis.
• Perform vendor reconciliations, including investigation and resolution of reconciling items related to provider payments, capitation, commissions, and vendor disbursements.
• Aid in monthly and year-end close and support timely and accurate financial reporting.
• Support system implementations, upgrades, and automation initiatives related to AP and payment operations.

Qualifications

• Bachelor’s degree in accounting, finance, or related field required.
• 1+ years of progressive accounts payable or accounting experience.
• Exposure to the 1099 reporting process.
• Experience performing vendor reconciliations and supporting month-end close.
• Ability to communicate clearly and professionally with vendors and internal teams.
• Detail-oriented with a focus on accuracy and compliance.
• Well-organized and able to manage multiple priorities under deadlines.
• Proficiency with ERP systems (QBO) and AP/workflow tools.
• Advanced Excel skills (pivot tables, XLOOKUP/VLOOKUP, reconciliation and data analysis).