Location Address: 900 Hope Way Altamonte Springs, FL 32714
Top Reasons To Work At AdventHealth Corporate
Immediate Health Insurance Coverage
Career growth and advancement potential
Full-Time, Monday – Friday
You Will Be Responsible For:
Accountable for ensuring Payer updates (policy, system edits, operational changes, etc.) are appropriate and the implementation of such change is in alignment with the terms of the contract. Once determined, appropriate action taken to either educate hospital departments of upcoming changes or challenge the implementation with the payer.
Remains current with all pertinent payer information and is responsible for sharing and educating hospital leadership and Ancillaries as appropriate. Ensures contract information is maintained in an organized manner and facilitates in the compliance of consistency of departmental operations.
Facilitates Regional PFS departments, Case Management, Denial Management and ancillary facilities in articulating operational contract issues to the Payers and provides the forum to effectively discuss and share information between AdventHealth and payers.
Maintains communication and coordinates with Payer to ensure timely execution of contract rate implementation.
Ensures hospital staff, leadership and ancillaries are aware of any payer policy updates, operational changes, and governmental initiatives that may have a direct or indirect impact on hospital operations or contract terms and rates. Guides and directs facilities on processes based on this communication.
Supports and serves as liaison between Florida Regional PFS departments, payers, co-workers, Case Management, ancillaries, various hospital departments and leadership relative to continued education and the resolve of operational issues.
Responsible for remaining current on regulatory changes that could impact reimbursement relative to CMS, Medicaid, Tricare and Workers Comp and effectively communicates this information with Managed Care team and other organizational leadership.
Extracts pertinent contract information to update database which provides reports for distribution to Senior Staff, AdventHealth Florida and Multi-State Managed Care Directors and Ancillaries.
Maintain Epic Certification (CPE) – Continuing Professional Education
What You Will Need:
Four to five years of experience in managed care, patient financial services or healthcare payer relations background
Bachelor’s degree in Business or Healthcare Administration or related field, preferred
Five to seven years in healthcare, hospital revenue cycle or payer/provider relations, preferred
Certification in Epic Contract Management, preferred
If you are Epic Accredited or Certified in hospital billing expected reimbursement contract build or have experience in other contract systems and would like to become an Epic contract builder, come join our exciting, fast paced department. Become an integral team member of the successful implementation of the Epic EMR and Patient Accounting software for AdventHealth.
This position is responsible for contract review and interpretation; as well as, the building and maintenance of rates and terms into designated contract management systems for AdventHealth Florida Division and Ancillaries. Precision of the contract build ensures payer accountability and compliance to the negotiated contract rates and terms. This affords AdventHealth leadership the foundation for reporting and determining overall payer performance and allows AdventHealth the ability to accurately model contracts for future negotiations. The accuracy of these builds is also essential for estimating month-end net patient revenue for the Florida division.
This position assists the Sr. Contract Manager with ensuring that preferred contract language provides for ease of interpretation and system adjudication. Provides guidance and direction to PFS, Central Denials, Patient Access and Managed Care staff regarding contract terms and policies including; governmental initiatives, rules and regulations. Develops and maintains a strong working relationship with AdventHealth Florida Division leadership, AdventHealth Central Denials, Regional Revenue Cycle leadership including CBO, UR, CM, Patient Access, Revenue Integrity, HIM, Ancillary facilities and other internal departments in order to ensure compliance and awareness of negotiated contract terms and rates.
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.