Analyst Reimbursement Managed Care - Remote

American Association of Integrated Healthcare Delivery Systems; Altamonte Springs (FL); Remote; USD 150,000 - 200,000; Full time

Job summary

A leading healthcare organization seeks a qualified professional for a remote role ensuring timely loading of provider information with Managed Care payers. Responsibilities include evaluating contractual adjustments and resolving claim denials. Candidates should have experience in healthcare reimbursement and strong analytical skills. A high school diploma is required, with a bachelor's degree preferred.

Benefits

Benefits from Day One

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Qualifications

• 3 years of relevant experience in healthcare reimbursement, including work with Commercial and Government payers.
• In-depth knowledge of reimbursement rules and regulations.
• Strong computer skills and ability to learn new technology applications.

Responsibilities

• Ensure timely and accurate loading of provider information with Managed Care contracted payers.
• Evaluate professional fee contractual adjustments for accuracy.
• Identify and recommend corrective action on payment variances.

Skills

Healthcare reimbursement experience

Payment variance software

Analytical reasoning

Interpersonal skills

Attention to detail

Education

High School Diploma or equivalent

Bachelor's in healthcare or business administration

Tools

Athena

Epic

Microsoft Office

Job description

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 8:00am to 5:00pm - Remote

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. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Managed Care

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 25016994

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.