Payer Manager - Onsite

AdventHealth Corporate

All the benefits and perks you need for you and your family:

• Benefits 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.

Shift : Monday-Friday

Job Location : Altamonte Springs, FL

The role you’ll contribute:

This position requires extensive knowledge and technical competence in Contract Administration by conducting necessary research, review and interpretation of Insurance Provider Manuals, payment methodologies, and reimbursement rates. A strong working knowledge of federal government and state specific payment methodologies to accurately calculate and maintain facility specific rates in the contract management systems for Florida and multi-state hospital providers is necessary.

Provides expert guidance to Regional Directors and Managed Care staff in reference to technical system and application issues, product builds, and calculation discrepancies. Produces reports and analyzes data to ensure a high degree of accuracy of rate calculation components. Demonstrates high level competency in analytical and critical thinking skills and effectively communicates key information to AH Revenue Cycle VP's and other leadership. Maintains strong working relationships with AH IT and Corporate HIM to collaboratively implement system updates and test new products for grouping and pricing accurately and effectively.

The value you’ll bring to the team:

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

Maintains Epic Certification (CPE) Continuing Professional Education.

Responds to frequent inquiries from the Corporate Net Revenue Accounting department to facilitate with month end net revenue calculations.

Responsible for accurately building rate component data into designated contract management system; being mindful of regulatory changes that impact estimated reimbursement.

Uses extensive knowledge and technical competencies to identify systematic issues that impact the

outcomes of net revenue reporting. Generates and analyzes daily audit and error detail out of the Contract Management system to timely identify and troubleshoot system issues or trends.

Contributes to the development and implementation of new systems by offering skilled feedback and

expertise in government reimbursement and system application strategies.

Efficiently and effectively engages AH IT, Corporate HIM, and other Revenue Cycle stakeholders as needed to build, test, and deploy a new product or price type in the contract management systems.

Independently prepares high level analytic information which is communicated and shared with AH Revenue Cycle leadership.

Stays informed of changes in the field of Managed Care and the objectives of the department.

Facilitates in the completion and coordination of special projects.

Initiates personal education and training in the areas of Managed Care and role related functions.

Qualifications

The expertise and experiences you’ll need to succeed:

EDUCATION AND EXPERIENCE REQUIRED:

• High School Grad or Equivalent and 4 years’ experience

• Four to five years of experience in managed care, patient financial services or healthcare payer relations background.

EDUCATION AND EXPERIENCE PREFERRED:

• Bachelor's degree in related field, i.e., business, healthcare

• Five to seven years in healthcare, hospital revenue cycle or payer/provider relations.

• Certification in Epic Contract Management

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Managed Care

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 23033755

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.