All the benefits and perks you need for you and your family:
· Benefits from Day One
· Paid Days Off from Day One
· Career Development
· Whole Person Wellbeing Resources
· Mental Health Resources and Support
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.
Schedule: Full Time
Shift : Monday - Friday
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.
· This position is under constant pressure and stress because of the deadlines. The ability to be well organized is a must in order to get regular workload and special assignments done on time.
· The individual in this position works with controllers, CFOs, accountants and Managed Care Directors. Has contact with other AHS entities’ personnel, etc. via telephone where friendliness, tact and courtesy is important in order to project the proper image for the corporation.
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.
· 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 demonstrating a thorough understanding of reimbursement methodologies and their impact on internal systems and other departments
· Contributes to the overall completion of the work product in group project situations
· Maintains and utilizes available resources to ensure work is completed accurately and timely
· Displays a willingness to grow and develop skills required to perform his/her job duties
· Takes the initiative to seek out education and training to stay informed of changes in the field of managed care
· Participates in meetings as assigned or requested
· Communicates problems and recommends solutions to Leadership
· Provides cross-training and support for Finance and other Managed Care staff
· Adheres to applicable internal policies, procedures, and guidelines as set forth by Adventist Health Systems, 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.
· Does not interfere with the ability of co-workers to complete their duties
The expertise and experiences you’ll need to succeed:
KNOWLEDGE AND SKILLS REQUIRED:
· Decision Support/Business Intelligence experience
· Proficient in Hospital / Physician Financial Analysis and Reimbursement
· Microsoft Office (PowerPoint, Word, Outlook, Visio, etc.)
· Must be highly proficient in the use of Microsoft Excel
· Excellent communication skills, both verbal and written are required.
· 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.
· Independent decisions are required in order to determine the best method to complete assigned tasks. However, the person in this position has latitude in developing a plan to reach the desired results
KNOWLEDGE AND SKILLS PREFERRED:
· Healthcare information systems (PCON, Cerner, Soarian)
· Business Intelligence Software (Qlikview, Tableau, SAP, etc.)
· Data warehousing tools (SQL Server, etc.)
· Microsoft Visual Basic/Access
EDUCATION AND EXPERIENCE REQUIRED:
· 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
EDUCATION AND EXPERIENCE PREFERRED:
· Master’s degree or CPA and 5+ years in managed care, patient financial services, health insurance claims processing, contract management, or manage care finance.
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
Req ID: 23015979
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.
Job Schedule: 901 INSPIRATION AVENUE
Pay Range: $28.279 - $42.418
Location: Maitland, FL
Job ID: 23015979
Job Family: Managed Care
Shift: 1 - Day