Managed Care Reimbursement Analyst

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. All the benefits and perks you need for you and your family: Benefits from

Day One:

Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100%

Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Schedule:

Full time

Shift:

Day (United States of America)

Address:

2600

LUCIEN WAY City:

MAITLAND

State:

Florida Postal Code:

32751

Job Description:

Demonstrated 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 Demonstrated strong computer software skills including Microsoft Office applications, with a proficiency in Microsoft Excel and the ability to work with and manipulate data within Reports, Formulas, Charts, and Pivot Tables Submits credentialing reports accurately and timely. Confirms provider information on credentialing applications and reports. Enters effective date and provider number information from payers into relevant systems. Reviews and resolves claim denials related to credentialing and enrollment status. Identifies and analyzes payment variances for professional fee contracts and government payers. Reviews reports to determine true variances based on reimbursement guidelines and contracted fee schedules. Liaises with payers to address issues and ensure accurate processing. Works closely with Managed Care contract administration to ensure accurate provider profiles. Maintains knowledge of current rules and regulations of Commercial and Government programs. Aggregates and categorizes variance types for management review. Serves as a resource for payment variance identification and education. Coordinates with billing support teams on identified payment variances and credentialing denials. Other duties as assigned.

Knowledge, Skills, and Abilities:

• In-depth knowledge of Commercial and Government program reimbursement rules and regulations [Required]
• Ability to research and interpret Commercial and Government payer rules and regulations [Required]
• Proficient in the use of payment variance software and tools [Required]
• Proficient understanding of variance reimbursement methodologies, auditing principles, and their application to healthcare [Required]
• Ability to learn new technology applications [Required]
• Excellent interpersonal skills [Required]
• Well-organized and detail-oriented with the ability to give attention to detail and accuracy [Required]
• Ability to complete assigned tasks with limited supervision [Required]
• System experience in identifying payment variances (Athena/Epic) [Preferred]
• Claim denial follow-up with payers [Preferred]
• Ability to identify process improvement opportunities and manage priorities to accomplish project deadlines and department goals [Required]
• Must demonstrate an ability and willingness to learn and adapt to a constantly changing reimbursement environment [Required]
• Independent decision-making required to determine the best method to complete assigned tasks [Required]

Education:

• Bachelor's [Preferred]
• High School Grad or Equiv [Required]

Field of Study:

• Healthcare business [Preferred]

Work Experience:

• 3+ relevant experience in healthcare reimbursement including commercial and government payers [Required]

Additional Information:

N/A Licenses and Certifications:

N/A Physical Requirements:

(Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$45,196.93 - $84,071.39 This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.