Analyst Reimbursement Managed Care - Remote

Academy of Managed Care Pharmacy; Maitland (FL); Remote; USD 55,000 - 75,000; Full time

Job summary

Join a leading healthcare organization as a Reimbursement Specialist, where you will ensure accurate provider loading and manage payment variances. This role requires strong analytical skills and knowledge of healthcare reimbursement rules. Work remotely and contribute to a collaborative team dedicated to enhancing patient care.

Benefits

Benefits from Day One

Career Development

Whole Person Wellbeing Resources

Mental Health Resources and Support

Qualifications

• 3+ years of healthcare reimbursement experience required.
• In-depth knowledge of reimbursement rules and regulations.

Responsibilities

• Ensure timely and accurate loading of providers with Managed Care contracted payers.
• Identify payment variances and collaborate with billing support teams.
• Analyze data for reimbursement trends and profile accuracy.

Skills

Analytical

Problem-Solving

Interpersonal

Detail-Oriented

Education

High School diploma or equivalent

Bachelor’s degree in healthcare, business administration, or related field

Tools

Microsoft Office

Athena/Epic

Payment variance software

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 means being part of a community that believes in the wholeness of each person and aims to uplift others in body, mind, and spirit. It’s a place to thrive professionally and grow spiritually by extending the healing ministry of Christ. We value who you are and the unique experiences you bring to our purpose-driven team, understanding that together we are stronger.

Job Location: Monday-Friday, 8:00 am to 5:00 pm - Remote

The role you’ll contribute:

Responsible for ensuring providers are loaded timely and accurately with Managed Care contracted payers. Evaluate professional fee contractual adjustments for accuracy according to various payer contracts and federally mandated guidelines. Support payment variance identification for the Physician Enterprise (PE) and collaborate with practice office operations, Managed Care contracting, Credentialing, Enrollment, and billing support teams to identify and recommend corrective actions on payment variances and provider profiles with payers.

The value you’ll bring to the team:

• Submit delegated and non-delegated credentialing reports after completion by MC Credentialing and Enrollment Teams.
• Confirm providers submitted on credentialing applications and reports are accurately and timely entered into payer systems and directories.
• Enter effective date and provider number information received from payers into Athena/Epic and MSOW Network Management, releasing held claims and updating practice status reports.
• Review and resolve claim denials related to credentialing and enrollment status of all employed providers.
• Identify payment variances for professional fee contracts and government payers, reviewing reports to determine true variances based on reimbursement guidelines.
• Liaise with payers to request provider profile updates and negotiate discounts within guidelines.
• Work closely with MC contract administration to ensure loaded contracts and provider specialties are accurate and updated.
• Maintain knowledge of current rules and regulations of Commercial and Government programs.
• Review contractual adjustments to determine causes and categorize variances for management review.
• Serve as a subject matter expert for payment variance identification and education.
• Meet with PE and MC as directed to update provider load, variance projects, and payer issues.
• Analyze data for reimbursement trends, load times, and profile accuracy.
• Coordinate with billing support teams on payment variances and credentialing denials.
• Complete special projects as assigned within specified timeframes.

The expertise and experiences you’ll need to succeed:

• High School diploma or equivalent (Required)
• 3+ years of healthcare reimbursement experience, including Commercial and Government payers (Required)
• Bachelor’s degree in healthcare, business administration, or related field (Preferred)
• In-depth knowledge of reimbursement rules and regulations for Commercial and Government programs
• Ability to research and interpret payer rules and regulations
• Proficiency in payment variance software
• Understanding of variance reimbursement methodologies and auditing principles
• Strong computer skills, including Microsoft Office
• Ability to learn new technology applications used by Adventist Health System
• Strong analytical, critical thinking, judgment, and problem-solving skills
• Excellent interpersonal skills
• Well-organized and detail-oriented
• Ability to work independently with limited supervision
• Experience with Athena/Epic in identifying payment variances
• Experience in claim denial follow-up with payers

Our people are passionate about their work, products, and customers. If you're seeking an opportunity to be part of a collaborative, innovative, and dedicated work family, we welcome your application.

This facility is an equal opportunity employer and complies with all relevant anti-discrimination laws. Salary ranges are reflective of the anticipated base pay, with individual compensation based on skills, experience, and other relevant factors. Ranges may vary by geographical location.