Analyst Reimbursement Managed Care - Remote

AdventHealth; Maitland (FL); Remote; USD 45,000 - 75,000; Full time

Job summary

Join a forward-thinking healthcare organization dedicated to uplifting individuals in body, mind, and spirit. This role offers a unique opportunity to engage in meaningful work while supporting the community. As a key player in reimbursement analysis, you'll ensure accurate provider loading and resolve claim denials, all while enjoying the benefits of remote work. With a focus on career development and whole-person wellbeing, this position is ideal for those looking to grow in a supportive environment. Embrace the chance to make a difference in healthcare while advancing your career.

Benefits

Benefits from Day One

Career Development Opportunities

Mental Health Resources

Remote Work Flexibility

Qualifications

• 3+ years of experience in healthcare reimbursement required.
• Knowledge of reimbursement rules for Commercial and Government programs.

Responsibilities

• Ensure timely loading of providers with Managed Care payers.
• Analyze data for payer reimbursement trends and load accuracy.

Skills

Analytical Reasoning

Problem-Solving

Critical Thinking

Microsoft Office Proficiency

Education

High School Diploma

Bachelor's Degree in Healthcare or Business

Tools

Athena

Epic Systems

Job description

Employer Industry: Healthcare Services

Why consider this job opportunity:
- Benefits from Day One
- Opportunity for career development and growth within the organization
- Support for whole person wellbeing, including mental health resources
- Remote work opportunity with a Monday-Friday schedule from 8:00 am to 5:00 pm
- Chance to be part of a community focused on uplifting others in body, mind, and spirit

What to Expect (Job Responsibilities):
- Ensure timely and accurate loading of providers with Managed Care contracted payers
- Evaluate professional fee contractual adjustments for accuracy in accordance with payer contracts and federally mandated guidelines
- Identify and recommend corrective actions on payment variances and provider profiles with payers
- Review and resolve claim denials related to credentialing and enrollment status
- Analyze data to provide insights on payer reimbursement trends and load accuracy for provider profiles

What is Required (Qualifications):
- High School diploma or equivalent required
- Minimum of 3 years of relevant experience in healthcare reimbursement, including Commercial and Government payers
- In-depth knowledge of reimbursement rules and regulations for Commercial and Government programs
- Strong analytical reasoning, critical thinking, and problem-solving skills
- Proficiency in Microsoft Office applications and payment variance software

How to Stand Out (Preferred Qualifications):
- Bachelor's degree in healthcare, business administration, or a related field
- Experience with Athena/Epic systems for identifying payment variances
- Strong interpersonal skills and detail-oriented approach
- Ability to learn new technology applications used by the employer
- Experience in claim denial follow-up with payers

#HealthcareServices #RemoteWork #CareerDevelopment #MentalHealthSupport #ReimbursementAnalysis

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