All the benefits and perks you need for you and your family:

Benefits from Day One

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday- Friday 8am-5pm hybrid or remote

Job Location : Remote or Maitland, FL if hybrid

The role you will contribute:

This position requires extensive knowledge and technical competence in Contract Administration. Under minimal supervision, provides necessary research, review and interpretation of Insurance Provider Manuals, payment methodologies, and reimbursement rates. Maintains a strong working knowledge of federal government and state specific payment methodologies in order to accurately calculate and maintain facility specific rates in the contract management systems for Florida and multi-state hospital providers, with a concentration on Medicare, state specific Medicaid, non-contracted payers, and Tricare. Consults with key revenue cycle stakeholders as well as the Finance, and Contract Management teams to share and receive key information relating to reimbursement interpretation for government and non-contracted products. Provides expert guidance to Regional Directors and Managed Care staff in reference to technical system and application issues, product builds and calculation discrepancies. Produces reports and analyzes data to ensure a high degree of accuracy of rate calculation components. Demonstrates high level competency in analytical and problem-solving skills and effectively communicates key information to AH Revenue Cycle VP's and other leadership. Maintains strong working relationships with AH IT and Corporate HIM to collaboratively implement system updates and test new products for grouping and pricing accurately and effectively.

The value you will bring to the team:

Systems/Analytics

Maintains Epic Certification (CPE) Continuing Professional Education

Uses acquired knowledge and discretion to build state and government fee schedules and rates into various contract management systems to ensure a high degree of accuracy in calculating net revenue for AH.

Strong ability to mentor and train complex systems to pertinent staff.

Responsible for ensuring system builds are audited to acceptable standards.

Responds to frequent inquiries from the Corporate Net Revenue Accounting department to facilitate with month end net revenue calculations.

Responsible for accurately building rate component data into designated contract management system being mindful of regulatory changes that impact estimated reimbursement.

Ensures thorough research and validation of non-contracted and government payer information * including regulatory and interim rate updates in relevant programs for Midwest, Southeast, Southwest, Mid-America and Florida regions.

Uses extensive knowledge and technical competencies to identify systematic issues that impact data outcomes of net revenue reporting.

Generates and analyzes daily audit and error detail out of Contract Management system to timely identify and troubleshoot system issues or trends. Pivots detail for distribution to assigned Contract Manager or analyst.

Contributes to the development and implementation of new systems by offering skilled feedback and expertise in the area of government reimbursement and system application strategies. Provides timely feedback related to system defects and required enhancements.

Initiates service tickets and participates with the troubleshooting with AH Support or Cerner Support, including the providing of technical details of identified issues, to ensure timely and appropriate response.

Encompasses a strong working knowledge of multiple systems in order to adequately troubleshoot and problem solve contract implementation or systemic system issues.

Efficiently and effectively engages AH IT, Corporate HIM, and other Revenue Cycle stakeholders when required to build, test and deploy a new product or pricer type in the contract management systems. Provides guidance and feedback in response to outcomes.

Responsible for understanding and maintaining a high level of expertise in the area of federal government and state specific rules relating to reimbursement methodologies.

Stays informed on updates or changes published by CMS, AHCA or other state specific regulatory agencies by reviewing government publications and subscribing to relevant list serves.

Responsible for ensuring systems are calculating accurately and updated timely and in accordance with effective dates of government and non-contracted rate updates including quarterly, annual, and interim updates which may impact payers and products managed by other Managed Care staff.

Communication/Coordination & Support

Independently prepares high level analytic information which is communicated and shared with AH Revenue Cycle leadership.

Effectively communicates with internal and external customers by adequately preparing and summarizing data related to revenue calculations and system issues and development.

Collaborates with Contract Administration, Revenue Cycle stakeholders and Finance to articulate any identified issues and specific parameters or limitations of the contract management systems as they relate to building government and state contracts.

Articulates escalated issues associated with high level stakeholder visibility in an effective and clear manner. Engages outside partners, vendors and leadership after identifying and quantifying the issue.

Supports the Managed Care Contract Administration, AH Central Denials team, and AH Regional PFS departments as applicable to assist with, identify and resolve operational, accounts receivable, billing, and other related issues.

Effectively communicates with coworkers, leadership and outside entities. Demonstrates the ability to represent ideas and facts clearly though verbal and written communication

Constructively discusses existing processes with Contract Managers, Central Denials, AH IT, Corporate HIM, and Contract Manager system personnel with intent to identify areas of improvement and maximize efficiency for all involved.

Provides and articulates key resource information and/or documentation to Managed Care teams, AH Regional PFS Departments as required and AH Revenue Cycle leadership. * Facilitates in the training and education of team members by developing training material and providing operational standards.

Stays informed of changes in the field of Managed Care and the objectives of the department.

Proactively seeks reimbursement methodologies and rate component data for government and non-contracted products for system calculation of claims.

Facilitates in the completion and coordination of special projects and tasks as requested by AH leadership.

Initiates personal education and training in the areas of Managed Care and role related functions such as new government regulations and reimbursement methodologies.

Supports AH Managed Care and AH Regional PFS Departments by providing education and training related to processes, software applications and government reimbursement methodologies.

Adheres to applicable internal policies, procedures and guidelines set forth by AdventHealth, its associated hospitals, and ancillaries during the execution of assigned duties.

The expertise and experiences youll need to succeed:

High School Grad or Equiv

4 of experience in managed care, hospital revenue cycle/patient financial services or healthcare insurance /provider relations related background Required

Microsoft Office

Strong analytical and problem-solving skills

Highly organized and efficient with time and resources

Ability to manage and summarize data in a meaningful way

Ability to lead and coordinate projects in circumstances of ambiguity and uncertainty

Detail oriented

Ability to prioritize and multi-task in a fast-paced environment

Excellent interpersonal and strong verbal and written communication skills

Professional, respectful and courteous

Knowledge of governmental payer functions, regulations and payment methodologies and structure of Medicare, state Medicaid, Tricare and other government payers.

Patient Accounting knowledge

CPT/HCPC coding knowledge

Preferred Qualifications:

Bachelor's in business or healthcare administration or related field Preferred

5 in healthcare, hospital revenue cycle or payer/provider relations Preferred

Certification in PB Resolute Epic Contract Management Preferred

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Managed Care

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 25026716

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.