Managed Care Payer Manager

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

Shift: Monday
- Friday 8am-5pm hybrid or remote

Job Location: Remote or Maitland, FL if hybrid

Joining Advent Health is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. Advent Health 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.

This position requires extensive knowledge and technical competence in Contract Administration. Under minimal supervision, provides necessary research, review and interpretation of Insurance Provider Manuals, payment methodologies, and reimbursement rates. Maintains a strong working knowledge of federal government and state specific payment methodologies in order to accurately calculate and maintain facility specific rates in the contract management systems for Florida and multi-state hospital providers, with a concentration on Medicare, state specific Medicaid, non-contracted payers, and Tricare.

Consults with key revenue cycle stakeholders as well as the Finance, and Contract Management teams to share and receive key information relating to reimbursement interpretation for government and non-contracted products. 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 problem-solving 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.

• Systems/Analytics
• Maintains Epic Certification (CPE) Continuing Professional Education
• Uses acquired knowledge and discretion to build state and government fee schedules and rates into various contract management systems to ensure a high degree of accuracy in calculating net revenue for AH.
• Strong ability to mentor and train complex systems to pertinent staff.
• Responsible for ensuring system builds are audited to acceptable standards.
• 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.
• Ensures thorough research and validation of non-contracted and government payer information
  * including regulatory and interim rate updates in relevant programs for Midwest, Southeast, Southwest, Mid-America and Florida regions.
• Uses extensive knowledge and technical competencies to identify systematic issues that impact data outcomes of net revenue reporting.
• Generates and analyzes daily audit and error detail out of Contract Management system to timely identify and troubleshoot system issues or trends. Pivots detail for distribution to assigned Contract Manager or analyst.
• Contributes to the development and implementation of new systems by offering skilled feedback and expertise in the area of government reimbursement and system application strategies. Provides timely feedback related to system defects and required enhancements.
• Initiates service tickets and participates with the troubleshooting with AH Support or Cerner Support, including the providing of technical details of identified issues, to ensure timely and appropriate response.
• Encompasses a strong working knowledge of multiple systems in order to adequately troubleshoot and problem solve contract implementation or systemic system issues.
• Efficiently and effectively engages AH IT, Corporate HIM, and other Revenue Cycle stakeholders when required to build, test and deploy a new product or pricer type in the contract management systems. Provides guidance and feedback in response to outcomes.
• Responsible for understanding and maintaining a high level of expertise in the area of federal government and state specific rules relating to reimbursement methodologies.
• Stays informed on updates or changes published by CMS, AHCA or other state specific regulatory agencies by reviewing government publications and subscribing to relevant list serves.
• Responsible for ensuring systems are calculating accurately and updated timely and in accordance with effective dates of government and…