AdventHealth Corporate Looking for Senior Managed Care Manager Finance at Maitland, FL Full Time

AdventHealth Corporate

Location Address: 2600 Lucien Way, Maitland, FL 32751

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

Career Development

Whole Person Wellbeing Resources

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.

Schedule: Full-Time

The role you’ll contribute:
The Senior Managed Care Manager Finance will address contracting and rate issues across AdventHealth hospitals, employed physician practices and ancillary providers. He/she will oversee extensive and complex financial and operational analyses of managed care contracts, rate 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 in all applicable AdventHealth markets.

The value you’ll bring to the team:
Supports Managed Care leadership in contract negotiations through detailed scenario modeling, comparative analysis, and benchmarking.

Evaluates and understands contractual language as it relates to reimbursement methodologies

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 Leadership.

Develops and performs analytical and planning functions in support of Managed Care decision making.

Participates in and/or leads the design/continuous improvement of the annual Managed Care revenue budgets

Utilizes a variety of software applications and data sources to develop and produce all Managed Care reporting

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

Provides oversight and training in the development of the senior financial analysts and financial analysts within the managed Care team.

Oversees timely and accurate financial analyses related to Managed Care net revenue.

Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by Leadership

Qualifications

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.

EPIC Resolute Hospital Billing Certification required or obtained within 180 days of hire

EPIC Resolute Professional Billing Certification required or obtained within 180 days of hire.

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