Managed Care Senior Analyst AdventHealth Corporate
Location Address: 1051 Winderley Place Suite 400 Maitland, FL
Top Reasons To Work At AdventHealth Corporate
Immediate Health Insurance Coverage
Career growth and advancement potential
Full-Time, Monday â“ Friday
You Will Be Responsible For:
Supports Managed Care leadership in contract negotiations through detailed financial modeling, comparative analysis, and benchmarking.
Evaluates and understands contractual language as it relates to reimbursement methodologies
Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue code
Develops and performs analytical and planning functions in support of Managed Care decision making
Leads in the development and review of the annual Managed Care Net Revenue budgets to support the annual AHS budget process.
Utilizes a variety of software applications and data sources to develop and produce the Managed Care Suite, DAA reports, other standard reporting, and adhoc reports
Utilizes a variety of software applications and data sources to ensure contract compliance with Charge Neutralization requirements within payor agreement
Completes timely and accurate financial analyses related to Managed Care net revenue.
Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by Leadership
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 demonstrating a thorough understanding of reimbursement methodologies and their impact on internal systems and other departments
What You Will Need:
Bachelorâ™s degree in Finance, Economics, Mathematics, Accounting, Statistics or related field
At least five years of analytic experience with emphasis in healthcare and/or clinical application and health insurance finances
Technical experience in utilizing analytical software tools and applications
Experience working with healthcare, insurance or claims data
Healthcare information systems (PCON, Cerner, Soarian, Athena)
Data warehousing tools (Access, SQL Server, etc
Intermediate level of proficiency in performing data and contract analytics; ability to effectively apply analytical and quantitative skills in reviewing payer reimbursement performance
Working knowledge of healthcare or insurance accounting methods and reporting, standards development, utilization measurements, and financial modeling
Masterâ™s degree or CPA and 5+ years in managed care, patient financial services, health insurance claims processing, contract management, or manage care finance (Preferred)
Microsoft Visual Basic (Preferred)
Masterâ™s degree in analytical field (Preferred)
Experience with statistical applications (Preferred)
Experience with analytics interfaces such as QlikView or Tableau (Preferred)
The Senior Managed Care Analyst is responsible for analytic strategies focused on Managed Care Payer Contract Performance. Areas of focus include modeling Payer Contract terms including Fixed, Percent of Charge, Fee Schedule and Value Based Methodologies. The Senior Managed Care Analyst engages clients (health plans, leaders and providers) in reviewing reimbursement data including but not limited to financial performance, contract compliance, denial reviews, and prospective modeling of proposed contract terms. The Senior Managed Care Analyst will provide analyses and strategic recommendations to maximize and optimize payer reimbursement in the aggregate as well as at key service line levels. The Senior Managed Care Analyst will have expertise in Governmental (Medicare, Medicaid, Tricare) and Commercial payer reimbursement language and methodologies. The Senior Managed Care Analyst works with Managed Care staff in all AHS Divisions, as well as payers in all markets. Actively participates in outstanding customer service and maintain relationships with clients who include AHS facility controllers, accountants and Managed Care Directors.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.