Analyst Reimbursement Managed Care - Remote

Texas Health Huguley FWS; Maitland (FL); Remote; USD 50,000 - 80,000; Full time

Job summary

An established industry player is seeking a dedicated Analyst for Reimbursement Managed Care. This remote role offers an opportunity to contribute to a vital aspect of healthcare, ensuring providers are accurately loaded with Managed Care contracts. You'll work closely with various teams to analyze payment variances and provide insights on reimbursement trends. If you thrive in a collaborative environment and are passionate about healthcare, this position is perfect for you. Join a community that values your unique contributions and supports your professional growth.

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.
• In-depth knowledge of reimbursement rules and regulations.

Responsibilities

• Ensure timely and accurate loading of providers with Managed Care contracted payers.
• Identify and resolve payment variances for professional fee contracts.

Skills

Healthcare Reimbursement

Analytical Reasoning

Problem Solving

Interpersonal Skills

Attention to Detail

Education

High School Diploma

Bachelor's in Healthcare or Business Administration

Tools

Athena/Epic

Microsoft Office

Payment Variance Software

Job description

Job Description - Analyst Reimbursement Managed Care - Remote (25016994)

Job Description

Analyst Reimbursement Managed Care - Remote (

Job Number:

25016994 )

Description

A ll 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.

Qualifications

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.