Provides the initial CPA and Waystar system training to the Denial Management Specialist employees and monitors their daily development.
Trains staff on all aspects of Denial Management processes, including but not limited to, Cerner Patient Accounting, appeal processes, posting of contractual adjustments and patient responsibility, updating health plans, the application of action codes and interpreting the Explanation of Reimbursement (EOR) from CCM.
Responsible for the continuous training, coaching and mentoring to the Denial Management Reimbursement Specialists through specialized training sessions on an individual basis or at the team level on operational procedures and systems such as CPA, CCM, Perceptive Content, Waystar, Mediregs and any other applications as needed.
Creates and maintains tools to improve work flow to maximize productivity and accuracy.
Evaluates training necessities relative to appeal process and payer payment methodology changes to support the Denial Management Specialists in their role of analyzing payment variances.
Develops training materials and creates computer-based learning modules to provide education/re-education to support staff for ensuring department goals are achieved.
Utilizing advanced level of knowledge of various training applications, can conduct training sessions with Denial Management Reimbursement Specialists clearly and effectively.
Responsible to identify and report system malfunctions to Denial Management Manager(s) throughout training process with employees.
Participates in meetings and discussions with Denial Management Executive Director, Denial Management Manager(s) and Denial Management Supervisors relative to training methods and educational goals for best practices for AdventHealth.
Assists management staff in disseminating procedural changes and system updates promptly.
Identifies system loading discrepancies within the contract management system and refers to the Supervisor, Contract Manager or Contract Administrator for correction.
Maintains thorough understanding of managed care payment methodologies and the principles of managed care. This includes interpreting multiple payment methodologies for payer types such as Commercial Managed Care, Managed Medicare, Managed Medicaid and other governmental payers based on state statues and federal law.
Researches and/or stays informed of changes in the field of Managed Care, Managed Medicare, Managed Medicaid, Auto, Tricare, Work Comp and the objectives of the department to provide additional educational opportunities to the staff as needed.
Can identify payer performance trends by identifying loading inaccuracies at the payer level.
Responsible for maintaining thorough knowledge of payer financial contract terms and conditions.
Readily able to adapt to new situations and changing priorities in order to accomplish department goals.
Strives towards meeting quality expectations to align performance with assigned roles and responsibilities. Escalates concerns or difficulties in meeting performance expectations in a timely manner for management action.
Maintains a positive working relationship with internal staff and external providers and payer representatives and acts in a professional, courteous manner at all times.
Performs other duties as assigned by management.
Adheres to applicable internal policies, procedures, and guidelines set forth by AdventHealth, its associated hospitals, physician groups, PHOs, and ancillaries during the execution of assigned duties.
Abides by all applicable rules, regulations, and laws prescribed by any authoritative governing body such as the State of Florida, AHCA, etc.
Deals with patient information in a sensitive manner to ensure respect and privacy for patient and expeditious handling of related issues.
Supports the overall mission of AdventHealth and the role of the Denial Management Department in that mission
What You Will Need:
High school diploma or equivalent
5+ years’ experience in Revenue Cycle
Advanced skill and knowledge of multiple regional databases such as Cerner Patient Accounting (CPA), Cerner Contract Management (CCM), Waystar, Perceptive Content, Adobe Captivate and any other applicable systems.
Maintains an intricate level of knowledge regarding Medicare Regulatory updates/changes published by CMS to maximize reimbursement.
Basic understanding of an explanation of benefits (EOB)
Basic knowledge of CPT, ICD-10, and HCPCS coding standards
Ability to communicate effectively in written and oral form with diverse populations
Interpersonal skills to promote teamwork throughout the Denials Management team
This position is responsible for training and educating the AdventHealth Denial Management team employees in Cerner Patient Accounting, Waystar and other applicable systems. Under general supervision of the Denial Management Manager, will be responsible for conducting specific process and payer training to maximize expected reimbursement for AdventHealth managed care contracts. This position will require knowledge and understanding of payer contracts. Responsible to build and maintain training materials as needed. Works with both Denial Management Leadership and staff to promote efficient and accurate training policies and practices. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
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.