AdventHealth Senior Compliance Analyst Managed Care in Maitland, Florida
Senior Compliance Analyst AdventHealth Corporate
Location Address: 900 Hope Way Altamonte Springs, FL 32714
Top Reasons To Work At AdventHealth Corporate
- Great benefits
- Immediate Health Insurance Coverage
- Career growth and advancement potential
- Full-Time, Monday – Friday
You Will Be Responsible For:
- Performs contract language review in accordance with state statutes, federal regulation and AdventHealth Managed Care policy.
- Maintain and report contract violations by payor, hospital, and AH Division to include related financial impact.
- Manage payor legal action through research, damages calculations, and organizing data/materials from other AdventHealth departments (i.e. medical records, itemized bills, etc.) within the scheduled timeframes.
- 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
- Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by Leadership
- Facilitate resolution to contract violations by leveraging knowledge of Medicaid contract requirements, regulations, and state specific appeal processes.
- Facilitate resolution to contract violations by leveraging knowledge of Medicare Advantage plans regulatory requirements and Medicare Advantage Appeal processes and requirements.
What You Will Need:
- 3 years Healthcare, Managed Care, Hospital or Ancillary claims analysis, Hospital or Ancillary claims payment, or related field with bachelor’s degree.
- 5 years Healthcare, Managed Care, Hospital or Ancillary claims analysis, Hospital or Ancillary claims payment or Related Field with Associates degree.
- 7 years Healthcare, Managed Care, Hospital or Ancillary claims analysis, Hospital or Ancillary claims payment or Related Field with High School diploma or equivalent
- Epic certification in Resolute Hospital Billing Expected Reimbursement Contracts Administration preferred and required within three months of employment
- Master’s degree or CPA and 5+ years in Managed Care, Managed Care finance, contract management, or health insurance claims processing, preferred
- E pic certification in Resolute Professional Billing Reimbursement Contracts Administration preferred
The Senior Compliance Analyst applies technical, analytical, and problem-solving skills to identify, quantify, and present contract compliance violations. He/she will perform extensive review of contract language, state and federal regulations, and payor practices to facilitate resolution of contract non-compliance. This person demonstrates attention to detail and competencies in contract language review, research, decision support, and financial analysis in the preparation and support of payor arbitrations. This person is responsible for compiling and analyzing multiple sources of data to support executive decision-making regarding contract violations. The Senior Compliance Analyst will have expertise in Commercial and Governmental (Medicare, Medicaid, Tricare) payer reimbursement language and methodologies. The Senior Compliance Analyst works with Managed Care staff in all AH Divisions, as well as payers in all markets. Actively participates in outstanding customer service and maintain relationships with clients who include AH Managed Care Directors, Contract Denial Specialists, other AdventHealth departments, payers and legal counsel.
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
Shift: 1 - Day
Travel: Yes, 25 % of the Time
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.