Capitation Specialist Jobs (NOW HIRING)

Verda Healthcare, Inc. is a Medicare Advantage Prescriptions Drug Plan (MAPD) organization committed to the idea that healthcare should be easily and equitably accessed by all, currently available in Texas and Arizona. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for an Accounts Payable Specialist – Medicare Advantage to join our growing company with many internal opportunities.

Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you’ll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity.

Align your career goals with Verda Healthcare, Inc. and we will support you all the way.

Position Overview
The Accounts Payable Specialist – Medicare Advantage is responsible for managing complex payment operations in a regulated health plan environment. This role supports claims-related provider payments, monthly capitation payments to delegated IPAs, capitation deductions (cap deducts), broker/agency/agent commissions, and vendor disbursements. The position owns payment data accuracy, reconciliations, and assists with monthly close activities while ensuring compliance with CMS regulations, internal controls, audit standards, and the end-to-end 1099 process.

This position reports to the AP Supervisor with dotted line to the Controller.

Responsibilities:

Provider Payments & Capitation

· Process and oversee monthly capitation payments to delegated IPAs, ensuring accuracy, timeliness, and contractual compliance

· Calculate, validate, and record capitation deductions (cap deducts), including adjustments related to claims runout, retro eligibility, recoveries, and reconciliation true-ups

· Manage claims-related provider payments, including retro adjustments, incentive payments, refunds, settlements, and other non-standard provider disbursements

· 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

Broker, Agency & Agent Commissions

· Process and reconcile broker, agency, and agent commission payments tied to Medicare Advantage enrollments

· Validate commission data accuracy across enrollment, commission, and financial systems

· Maintain broker/agent master data, payment setup, and tax documentation

· Support internal, external, and regulatory audits related to commission payments

Accounts Payable Operations & Data Ownership

· Process high-volume, complex AP transactions for Medicare Advantage administrative and operational vendors

· Prepare weekly check run for Finance approval and processing

· Review invoices and other related documents to resolve exceptions prior to posting invoices for payments

· Performs 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

· Ensure proper invoice coding, approvals, accruals, and documentation in compliance with CMS regulations and internal control standards

· Investigates and escalates issues associated with invoices and communicates as appropriate

· Maintain audit-ready support for CMS audits, internal audits, and financial audits

Tax Reporting & Compliance

· 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

Reconciliations & Close Support

· 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

· Assist with monthly and year-end close and support timely and accurate financial reporting

Process Improvement & Leadership

· Support the initiatives to improve AP, capitation, provider payment, and commission processes for greater efficiency, accuracy, and control

· Support system implementations, upgrades, and automation initiatives related to AP and payment operations

Preferred Qualifications:

· Experience with multiple entities and consolidation, with an understanding of expense allocation preferred

· Familiarity with a health plan or managed care organization

· Experience with Medicare Advantage capitation models, delegated IPA payments, and cap deducts

· Hands-on experience with claims-related provider payments and broker/agent commission processing

· Understanding of CMS regulations, Medicare Advantage compliance and audit requirements

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time employment
Location: Huntington Beach, CA

Compensation Range: $70,304-$72,000

Actual compensation offered will be determined based on experience, qualifications, skills, internal equity (if available), and geographic location. This position may also be eligible for performance-based incentive compensation and benefits.

Benefits:

• 401(k)
• Paid time off (vacation, holiday, sick leave)
• Health insurance
• Dental Insurance
• Vision insurance
• Life insurance

Schedule:

• Full-time onsite (100% in-office)
• Hours of operations: 9am – 6pm
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.

Ability to commute/relocate:

• Reliably commute or planning to relocate before starting work (Required)

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

*Other duties may be assigned in support of departmental goals.

Minimum 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)