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Supports Managed Care leadership in contract negotiations through detailed scenario modeling, comparative analysis, and benchmarking.
Evaluates and understands contractual language as it relates to reimbursement methodologies
Applies significant understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue codes
Demonstrates proficiency with various reimbursement methodologies including, Per Diem, DRG, fee schedules, and percent of charge
Demonstrates extensive knowledge of both commercial and governmental payers for modeling and analyzing contract proposals
Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Leadership.
Develops and performs analytical and planning functions in support of Managed Care decision making.
Participates in and/or leads the design/continuous improvement of the annual Managed Care revenue budgets
Utilizes a variety of software applications and data sources to develop and produce all Managed Care reporting
Utilizes a variety of software applications and data sources to ensure contract compliance with Charge Neutralization requirements within payor agreements
Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance
Provides oversight and training in the development of the senior financial analysts and financial analysts within the managed Care team.
Oversees timely and accurate financial analyses related to Managed Care net revenue.
Demonstrates independent thinking and creativity in development of contract models, standard reports and ad hoc analyses
Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by Leadership
Adapts to new situations and changing priorities to accomplish project deadlines and department goals
Maintains a high degree of accuracy while using large amounts of data
Prepares well-organized project-specific documentation, that includes at a minimum, analytic methods used, key decision points and caveats, with sufficient detail to support comprehension and replication.
Demonstrates strong project management and organizational skills by maintaining up-to-date project lists to assist in setting appropriate project priorities
Applies technical expertise in the development of models and decision support information
Assures the application of appropriate standards of data analysis and that all analytics are quality checked
Serves as process and content expert by developing and maintaining a thorough understanding of reimbursement methodologies and their impact on internal systems and other departments
What You Will Need:
Education and Experience Required:
Bachelor’s degree or equivalent years of experience in managed care, patient billing services, health insurance claims processing, contract management, finance or accounting.
Licensure, Certification or Registration Required:
EPIC Resolute Hospital Billing Certification required or obtained within 180 days of hire
EPIC Resolute Professional Billing Certification required or obtained within 180 days of hire.
Knowledge and Skills Required:
Detail oriented; excellent problem-solving skills
Excellent verbal and written communication skills
Advanced Microsoft Excel skills
Microsoft Word skills
Microsoft Access skills
The Senior Managed Care Manager Finance will address contracting and rate issues across AdventHealth hospitals, employed physician practices and ancillary providers. He/she will oversee extensive and complex financial and operational analyses of managed care contracts, rate proposals and other varied payment methodologies, develop and track key performance indicators; and conduct ad hoc analyses of specific managed care issues. He/she will work with managed care staff in all applicable AdventHealth markets.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.