Medical Economics Supervisor Managed Care

1103 Team Member Services; Orlando (FL); Hybrid; USD 67,000 - 124,000; Full time

Benefits offered by this job

Medical

Dental

Vision Insurance

Life Insurance

Disability Insurance Paid Time Off

403-B Retirement Plan

4 Weeks 100% Paid Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources and Support

Pet Benefits

Job summary

AdventHealth in Maitland, FL is seeking a data analytics professional to lead complex medical economic projects and evaluate financial data within value-based reimbursement models.

You will manage data analysis, prepare documentation, and present results to executives, while collaborating across regional teams in a hybrid setting. Bachelor’s degree is required; Master’s preferred, with 2+ managerial and 5+ analytics experience in healthcare.

Qualifications

• Bachelor's degree in a related field required.
• Master's degree preferred.
• Field of study includes Finance, Health Care Administration, Accounting, Mathematics, or Health Informatics.

Responsibilities

• Other duties as assigned.
• Accumulates data, interprets results, makes recommendations, and influences outcomes.
• Prepares well-organized project documentation.
• Leads complex medical economic projects related to value-based contract modeling.
• Initiates projects, identifies, and completes key deliverables to meet business objectives.
• Conducts research and analyzes managed care data from various financial systems and tools.
• Reviews and analyzes complex healthcare data, including financial modeling and risk forecasting.
• Implements improvements in quality control and reporting timeliness.
• Manages, collects, analyzes, and interprets health utilization and financial data.
• Uses knowledge of healthcare managed care contracts and administrative claims data to interpret and analyze data.
• Reviews existing models, implements them on new projects, and designs new solutions for data and analytic challenges.
• Identifies risks associated with various reimbursement structures.
• Produces prospective analyses on new ventures, products, and services.
• Prepares and presents analytics or project results to key stakeholders for decision-making.
• Evaluates and understands contract language related to reimbursement methodologies.
• Applies understanding of medical coding systems affecting claims adjudication, including ICD-9/10, CPT, HCPCS II, DRG, and revenue codes.
• Proficient with reimbursement methodologies such as Per Diem, DRG, fee schedules, and percent of charge.
• Recommends contractual payment term changes to achieve net revenue targets developed by Regional Managed Care Directors and Contract negotiators.
• Oversees standard and ad-hoc reports, analytical modeling, and consulting on provider-specific negotiations in multiple regions.

Skills

Value-based care

Population health

Managed care

Claims analytics

MS Excel

Interpersonal skills

Education

Bachelor's degree

Master's degree

Job description

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.

Benefits from Day One:

• Medical
• Dental
• Vision Insurance
• Life Insurance
• Disability Insurance Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule:

Full time Shift: Day (United States of America) Address: 900 HOPE WAY City: ALTAMONTE SPRINGS State: Florida Postal Code: 32714

Job Description:

• Other duties as assigned.
• Accumulates data, interprets results, makes recommendations, and influences outcomes.
• Prepares well-organized project documentation.
• Leads complex medical economic projects related to value-based contract modeling.
• Initiates projects, identifies, and completes key deliverables to meet business objectives.
• Conducts research and analyzes managed care data from various financial systems and tools.
• Reviews and analyzes complex healthcare data, including financial modeling and risk forecasting.
• Implements improvements in quality control and reporting timeliness.
• Manages, collects, analyzes, and interprets health utilization and financial data.
• Uses knowledge of healthcare managed care contracts and administrative claims data to interpret and analyze data.
• Reviews existing models, implements them on new projects, and designs new solutions for data and analytic challenges.
• Identifies risks associated with various reimbursement structures.
• Produces prospective analyses on new ventures, products, and services.
• Prepares and presents analytics or project results to key stakeholders for decision-making.
• Evaluates and understands contract language related to reimbursement methodologies.
• Applies understanding of medical coding systems affecting claims adjudication, including ICD-9/10, CPT, HCPCS II, DRG, and revenue codes.
• Proficient with reimbursement methodologies such as Per Diem, DRG, fee schedules, and percent of charge.
• Recommends contractual payment term changes to achieve net revenue targets developed by Regional Managed Care Directors and Contract negotiators.
• Oversees standard and ad-hoc reports, analytical modeling, and consulting on provider-specific negotiations in multiple regions.

Schedule/shift:

Hybrid (Monday, Wednesday, Thursday on site in Maitland, FL Monday-Friday: 8am-5pm est)

Knowledge, Skills, and Abilities:

• Working knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation [Preferred]
• Working knowledge of population health, utilization measurement, and claims analytics [Preferred]
• Managed Care, Patient Financial services, health insurance claims processing, contract management, or medical economics preferred [Preferred]
• Proficiency in understanding professional and facility claims and managed care concepts such as risk adjustment, capitation, FFS, DRG, APG, APCs and other payment mechanisms [Preferred]
• Experience in modeling financial impact of changes and presenting the findings to executives [Preferred]
• Strong ability to handle multiple projects including problem solving, research, analysis, and communication in a fast-paced environment [Preferred]
• In depth knowledge of Commercial and Government programs reimbursement rules and regulations Required [Preferred]
• Intermediate level of proficiency working with MS Excel including Formulas, calculations, charts, and graphs [Preferred]
• Strong skills in analytical/problem solving and presentations required [Preferred]
• Excellent interpersonal skills [Preferred]
• Ability to complete assigned tasks with very limited supervision [Preferred]

Education:

• Bachelor's [Required]
• Master's [Preferred]

Field of Study:

in Finance, Health Care Administration, Accounting, Mathematics, or Health and Informatics or related field in a related field

Work Experience:

• 2+ managerial experience [Required]
• 5+ experience performing data, financial and/or risk analytics in a healthcare environment [Required]

Licenses and Certifications:

• Epic Resolute Hospital Billing Charging (EPIC RHBC) [Preferred]

Physical Requirements:

(Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/23km2677

Pay Range:

$66,830.40 - $124,300.80

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

Equal Opportunity employer:

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

Christian mission statement:

As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we’re committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.