Analyst Reimbursement Managed Care - RemoteMaitland, FL

Analyst Reimbursement Managed Care Remote

Hospitals, medical centers, and facilities need more than physicians, nurses, and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady, and experienced team working behind the scenes to make sure communities around the country receive the health care they need.

If you've also been interested in working in the health care field but aren't a health care provider, a corporate career at AdventHealth may just be the perfect fit. We're a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety, and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional, and spiritual needs of every patient.

Start your journey with a health care career at AdventHealth Corporate.

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam, and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

The role you'll contribute:

Responsible for ensuring the providers are loaded timely and accurately with Managed Care contracted payers. Responsible for evaluating professional fee contractual adjustments for accuracy in accordance with various payer contracts and/or federally mandated guidelines. This position supports the payment variance identification for the Physician Enterprise (PE) and works closely with practice office operations staff, Managed Care (MC) contracting, MC Credentialing and Enrollment, and billing support teams to identify and recommend corrective action on payment variances and provider profiles with the payers.

The value you'll bring to the team:

• Submits the delegated and nondelegated credentialing reports once all credentialing and enrollment tasks have been completed by the MC Credentialing and Enrollment Teams.
• Responsible for confirming the providers submitted on the credentialing applications and the delegated and nondelegated credentialing reports are entered accurately and timely into the payer systems and directories.
• Enters effective date and provider number information received from the payers in Athena/Epic and MSOW Network Management thus releasing held claims and updating the status report for the practices.
• Reviews and resolves claim denials that are related to the credentialing and enrollment status of all AH employed providers.
• Responsible for identifying payment variances for professional fee commercial contracts and government payers. Reviews reports generated by Athena and/or PED to determine of the variances listed in the report, which are the true variances (under/overpayments) based on reimbursement guidelines from past billing/payer experience, payer websites, government updates, contracted fee schedules, etc.
• Liaisons with payer as directed by management to request provider profile updates, payment and/or within given guidelines, negotiates/approves discount.
• Closely works with MC contract administration and keeps open dialogue to ensure loaded contracts and provider specialties are accurate and updated as directed by management.
• Maintains a working knowledge of current rules and regulations of Commercial and Government programs.
• Reviews contractual adjustments to determine cause, aggregates and categorizes variance types in organized manner for management review.
• Serve as AdventHealth's subject matter resource for Commercial and Government payment variance identification, and education.
• Meets with PE and MC as directed by management to update current provider load, variance projects and specific payer issues.
• Analyzes data to provide payer reimbursement trends, payer load times, and load accuracy for provider profiles.
• Coordinates with billing support teams as directed by management on identified payment variances and credentialing denials.
• Completes special projects as assigned by the reimbursement manager within the time frame requested.

The expertise and experiences you'll need to succeed:

Qualifications

• High School or equivalent degree Required
• 3 relevant experience in healthcare reimbursement including Commercial and Government payers Required
• Bachelor's in healthcare, business administration or related field Preferred
• In depth knowledge of Commercial and Government program reimbursement rules and regulations
• Ability to research and interpret Commercial and Government payer rules and regulations
• Proficient in use of payment variance software
• Possess an understanding of variance reimbursement methodologies, auditing principles and their application to healthcare
• Strong computer software skills including Microsoft Office applications
• Ability to learn new technology applications used by Adventist Health System
• Strong analytical reasoning, critical thinking, judgment and problem solving skills in order to independently assess, interpret and address complex issues in a continually changing environment
• Excellent interpersonal skills
• Well organized and detail-oriented
• Ability to complete assigned tasks with limited supervision
• System experience in identifying payment variances (Athena/Epic)
• Claim denial follow up with payers

Our people are passionate about what they do, the product they sell, and the customers they serve. If you're looking for an opportunity to be a part of a work family that values collaboration, innovation, and dedication, we're the right company for you.

This facility is an equal opportunity employer and complies with federal, state, and local anti-discrimination laws, regulations, and ordinances.