All the benefits and perks you need for you and your family:
Benefits from Day One
Paid Days Off from Day One
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.
Shift: M-F 8am-5pm
Location: Altamonte Springs, FL
The role you’ll contribute:
The Manager will address contracting and rate issues across Adventist Health Systems hospitals and owned physician practices. He/she will oversee extensive and complex financial and operational analyses of managed care contracts, proposals and other varied payment methodologies, develop and track key performance indicators; and conduct ad hoc analyses of specific managed care issues. He/she will work with managed care staff both in the Florida and Multi-State Divisions of AHS. He/she will represent AHS managed care to payers in all AHS markets.
The value you’ll bring to the team:
Applies significant understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue codes
Demonstrates proficiency with various reimbursement methodologies including, Per Diem, DRG, fee schedules, and percent of charge
Demonstrates extensive knowledge of both commercial and governmental payers for modeling and analyzing contract proposals
Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators.
Utilizes a variety of software applications and data sources to develop and produce the Managed Care Suite, DAA reports, other standard reporting, and adhoc reports
Utilizes a variety of software applications and data sources to ensure contract compliance with Charge Neutralization requirements within payor agreements
Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance
The expertise and experiences you’ll need to succeed:
Bachelor’s degree or equivalent years of experience in managed care, patient billing services, health insurance claims processing, contract management, finance or accounting.1 year of retail or mail-order pharmacy setting.
Experience with the following software preferred: SQL, McKesson Pathways Contract Manager, SunCare, McKesson Trendstar / HPM, McKesson Series AS400, and/or Clickview
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.