AdventHealth Senior Managed Care Analyst in Maitland, Florida
All the benefits and perks you need for you and your family:
Benefits from Day One
Whole Person Wellbeing Resources
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.
The role you’ll contribute:
The Senior Managed Care Analyst applies technical, analytical, and problem-solving skills to provide financial modeling solutions/improvements within the Managed Care Finance department. He/she will complete extensive and complex financial and operational analyses of managed care contracts and proposals, analyze fee schedules, and determine contract compliance. This person demonstrates attention to detail and competences in decision support and reporting through converting raw data into useful and actionable information. This person is responsible for compiling and analyzing data as well as for creating meaningful applications to support executive decision making. Character traits include: strong work ethic, trainability, communicative, team player all with a positive “can do” attitude. Intermediate Excel skills required. He/she will work with managed care staff both in the Florida and Multi-State Divisions of AHS, as well as represent AHS managed care to payers in all AHS markets.
The value you’ll bring to the team:
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 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 Managed Care Directors and Contract negotiators.
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 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 financial analysts within the department
Completes 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
Changes and manages 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.
The expertise and experiences you’ll need to succeed:
Position requires a level of knowledge and training obtained through a college education. A Bachelor’s degree in Business, Accounting, Finance, Information Systems, or related.
3-5 years of hospital finance/healthcare experience
In lieu of education requirement, 10+ years in Healthcare Revenue Cycle and/or Managed Care contracting required
Decision Support/Business Intelligence experience
Proficient in Hospital / Physician Financial Analysis and Reimbursement
Microsoft Office (PowerPoint, Excel, Word, Outlook, Visio, etc.)
The Senior Managed Analyst role requires experience in Financial reporting and extensive knowledge in Managed Care payment methodologies for all types of healthcare entities (hospital, physician, ancillaries, etc), Must demonstrate an ability and willingness to learn and adapt to a constantly changing reimbursement environment.
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
Category: Managed Care
Organization: AdventHealth Corporate
Schedule: 1 - Day
Req ID: 22027896
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.