Capitation Revenue Specialist

Sandhills Center   West End, NC   Full-time     Administration / Clerical
Posted on September 13, 2023

Capitation Revenue Specialist


Sandhills Center is a Local Management Entity-Managed Care Organization (LME-MCO) serving people in eleven counties in central North Carolina.

Duties: The purpose of this position is to reconcile monthly Medicaid PMPM capitation payments to Medicaid eligibles to ensure Sandhills receives and accounts for all Medicaid funding.



• Reconcile Medicaid monthly reconciliation of the Per Member Per Month (PMPM) to ensure receipt of all Medicaid funds.

• The position is responsible for analyzing the data and developing and submitting reports for management and NC Medicaid requirements.

• Recoup additional funds owed to MCO from NC Medicaid if required. Prepare various spreadsheets and reports as requested to assist with accurate record-keeping and reconciliation of general ledger accounts and analysis for risk management.

• Be cross-trained on various duties for continuity of knowledge, experience and stability of all accounting and claims responsibilities.

• Maintenance of Electronic Files/Databases Responsible for maintaining electronic capitation/eligibility files.


Minimum Requirements:

Graduation from a high school including or supplemented by basic courses in bookkeeping or accounting and three years experience in bookkeeping or accounting clerical work in an accounting office; or an equivalent combination of education and experience. (Completion of a one or two-year business course in an accredited community college or business school including or supplemented by basic courses in bookkeeping or accounting may be substituted for two and three years of the required experience respectively.)


Sandhills Center offers an Excellent Benefits package, including Local Government Retirement and 401k. Sandhills Center is a drug-free workplace; drug testing is required.


Sandhills Center is an Equal Employment Opportunity (EEO) employer and does not discriminate on the basis of race, color, national origin, religion, gender, age, veteran status, political affiliation, sexual orientation, marital status or disability (in compliance with the Americans with Disabilities Act) with respect to employment opportunities.