Durham, North Carolina
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Posted: 07-May-25
Location: Maitland, Florida
Categories:
Internal Number: 25017121
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. It’s 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.
Job Location: Monday-Friday 8am-5pm Hybrid on-site
The role you’ll contribute:
This position is responsible for physician contract review and interpretation; as well as, the building and maintenance of rates and terms into designated contract management systems for Florida and multi-state providers. Precision of the contract build ensures payer accountability and compliance to the negotiated contract rates and terms and provides appropriate reconciliation of patient accounts and estimates. This affords AdventHealth leadership the foundation for reporting and determining overall payer performance and allows AdventHealth the ability to accurately model contracts for future negotiations. The accuracy of these builds is also essential for estimating month-end net patient revenue. Provides guidance and direction to PFS, Central Denials, Patient Access and Managed Care staff regarding contract terms and policies including; governmental initiatives, rules and regulations. Develops and maintains a strong working relationship with AdventHealth Florida and Multi-state Division leadership, Managed Care Reimbursement team, Regional Revenue Cycle leadership, Finance/Accounting, physician practices and AH Physician Enterprise in order to ensure compliance and awareness of negotiated contract terms and rates.
The value you’ll bring to the team:
- Systems * Uses acquired knowledge, experience and contract details to load, maintain and test contract management systems with a high level of accuracy of payment calculations. * Responsible for netting down system-wide accounts receivable. * Updates contract information in appropriate programs for assigned contracts. * Performs necessary research to obtain and maintain non-contracted payer reimbursement including Medicare, Medicaid, Tricare and other gov’t payers. * Responsible for ensuring accurate patient estimation through accurate calculation of estimated reimbursement. * Periodically audits contract management systems to ensure accurateness. * Provides the necessary feedback regarding system failures or inefficiencies so that the operational function of contracts and labor performance is not compromised. * Responsible for timely entry of contract data into the Managed Care database which includes addition of new payors, renewals and terminations to ensure the accuracy of reporting provided to all providers. * Works closely with physician group billing and system departments to resolve contract load issues and identify trends to ensure contract management systems are accurate and working appropriately.
- Communication * Effectively communicates with staff, leadership, payors and/or providers. Provides * Clearly and successfully represents self and this organization in a professional, * courteous manner. * Participates in meetings as assigned or requested. * Deals with patient information in a sensitive manner to ensure respect and privacy * for patient and expeditious handling of related issues. * During negotiations of the contract, works with the managed care team and other internal departments to identify issues or limitations of the contract that could have a negative impact on contract operations and administration. * Provides follow-up as appropriate with internal departments, providers and * leadership regarding parameters or limitations of contract fee schedule. * Support and Liaison-15% * Supports the overall mission of Advent Health and the role of the Managed * Care Department in that mission. * Demonstrates an eagerness to assist co-workers in the completion of tasks as needed. * Performs special projects and tasks as requested by senior staff and leadership. * Supports the contracting team, internal departments and providers as applicable to * assist with, identify and resolve operational, accounts receivable, billing and other * related issues. * Serves as liaison between Managed Care and provider groups by providing continual * education, support and training for the application of contracts as needed. * Demonstrates and encourages a team environment between hospital departments, * regions, payors and provider groups.
- Information * Keeps all pertinent payor information up to date for distribution to AH Regional Managed Care Departments. * Maintains contract information in an organized manner to promote consistency in departmental operations. * Extracts pertinent contract information to update database which provides reports for distribution to senior staff, AH Multistate Managed Care Directors and provider groups. * Responsible for remaining current on regulatory updates and rate changes that affect Medicare, Medicaid and TriCare reimbursement for contract loading and analysis purposes. * Obtains, updates, and disseminates quarterly fee schedule updates (eg Injectables, Immunizations) to all appropriate parties including, but not limited to physician team * members, physician billing departments and AH Physician Enterprise.
- Development, Education and Training * Maintains Epic Certification (CPE) Continuing Professional Education. * Displays a willingness to grow and develop skills required to perform his/her job duties and assist in the training and education of team members. * Takes the initiative to seek out education and training experience when there is a need and to stay informed of changes in the field of managed care and the objectives of the department. * Leads or facilitates in education of staff of Florida and Multi-State AH physician groups as requested. * Actively participates in providing constructive feedback and ideas for new development of contract management systems. * Deadlines, Timeliness and Performance Standards-10% * Completes assigned tasks in the appropriate time period and maintains an acceptable * workplace. * In group situations, effectively contributes to the overall completion of work product * according to the applicable directive and deadline. * Does not interfere with the ability of co-workers to complete duties. * Readily able to adapt to new situations and changing priorities in order to accomplish * department goals. * Adheres to applicable internal policies, procedures and guidelines set forth by AdventHealth, its associated hospitals, physician groups, PHO’s and ancillaries during the execution of assigned duties. * Abides by all applicable rules, regulations and laws prescribed by any authoritative * governing body such as state regulations, AHCA, etc.
The expertise and experiences you’ll need to succeed:
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EDUCATION AND EXPERIENCE REQUIRED:
- Four plus years of experience in managed care, hospital revenue cycle/patient financial services or healthcare insurance /provider relations related background.
EDUCATION AND EXPERIENCE PREFERRED:
- Bachelor’s degree in business or healthcare administration or related field
- Five plus years in healthcare, hospital revenue cycle or payer/provider relations
- Four plus years of experience in managed care, hospital revenue cycle/patient financial services or healthcare insurance /provider relations related background.
Qualifications Preferred:
- EPIC Credential (EPIC CRED) needed 60 days post hire date
Must Have:
- Detail oriented
- Microsoft Office
- Assertive
- High degree of competency in contract language interpretation
- Ability to problem solve and think analytically
- Strong organizational skills
- Effectively communicate with all department levels
- Ability to grow strong relationships
- Certification in Epic Contract Management
- Patient Accounting knowledge
- CPT/HCPC coding knowledge
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.
