Experience Inc. Jobs

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.

Job Location : Monday-Friday

The role you’ll contribute:

This position requires the ability to understand and interpret payer contract terms, complex reimbursement schedules, payment policies, patient accounting billing information and other sources of data to build, test, audit, and preserve the integrity of reimbursement calculation and contract term accuracy for AdventHealth providers.

This position requires extensive knowledge and technical competence in Epic Hospital Contract Management. Under minimal supervision, provides necessary research, review and interpretation of insurance provider manuals, contract language, payment methodologies, and reimbursement rates. 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 managed care, 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.

The value you’ll bring to the team:

Systems/Analytics

• Under minimal direction and supervision, demonstrates proficiency or advanced functional knowledge of Epic to build, test, and maintain complex reimbursement structures with a high degree of accuracy.

• Follows AIT's policies and procedures for updates and maintenance in the Epic environments platform.

• 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.

• 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 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.

• Ensures thorough research and validation of non-contracted and government payer information, including regulatory and interim rate updates in relevant programs for AdventHealth.

• 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.

• Responsible for ensuring that the contract image database is maintained with current information that accurately represents contract activities. This includes all correspondence and contract language, including rate updates, to the Information Systems Coordinator for scanning with appropriate filing form for the purpose of reporting accurate information to hospital and ancillary department leadership.

• Contributes to the development and implementation of new systems by offering skilled feedback and expertise in 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.

• 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.

Communication/Coordination & Support

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

• Effectively communicates with internal and external customers by adequately preparing and summarizing data related to revenue calculations, system issues and development.

• Collaborates with Contract Administration, Revenue Cycle stakeholders and Finance to articulate any identified issues and specific parameters or limitations of the contract management systems as they relate to building managed care government and state contracts.

• Articulates escalated issues associated with high level stakeholder visibility in an effective and clear manner. Engages outside partners, vendors, and leadership after identifying and quantifying the issue.

• Supports the Managed Care Contract Administration, AH Central Denials team, and AH Regional PFS departments as applicable to assist with, identify and resolve operational accounts receivable, billing, and other related issues.

• Effectively communicates with coworkers, leadership, and outside entities. Demonstrates the ability to represent ideas and facts clearly though verbal and written communication.

• Constructively discusses existing processes with Contract Managers, Central Denials, AH IT, Corporate HIM, with intent to identify areas of improvement and maximize efficiency for all involved.

• Facilitates in the training and education of team members by developing training material and providing operational standards.

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

• Proactively seeks reimbursement methodologies and rate component data for government and non-contracted products for system calculation of claims.

• Facilitates in the completion and coordination of special projects and tasks as requested by AH leadership.

• Initiates personal education and training in the areas of Managed Care and role related functions such as new government regulations and reimbursement methodologies.

• Supports AH Managed Care and AH Regional PFS Departments by providing education and training related to processes, software applications and government reimbursement methodologies.

• Adheres to applicable internal policies, procedures and guidelines set forth by AdventHealth, its associated hospitals, and ancillaries during the execution of assigned duties.

Deadlines and Performance Standards

• Can successfully prioritize when faced with requests, demands and deadlines.

• Effectively uses all information sources to achieve results.

• Demonstrates a strong ability to perform a broad range of responsibilities independently.

• Makes a valuable contribution to the team objectives and completion of work.

• Is dependable in achieving results within expected time periods.

• Performs special projects and tasks as requested by senior staff and leadership in accordance with AdventHealth's strategic timelines.

Development, Education and Training

• Maintain Epic Certification (CPE) – Continuing Professional Education.

• Follows and participates in applicable Epic forums related to Epic Contracts and Managed Care and brings information and opportunities forward for discussion and review.

• Responsible to remain current on regulatory changes that could impact reimbursement relative to the Centers for Medicare and Medicaid (CMS), Tricare and Workers Comp and effectively communicates this information with Managed Care team and other organizational leadership.

• Maintains 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 with a concentration on Medicare, state specific Medicaid, non-contracted payers, and Tricare.

• Demonstrates a desire to grow and develop new skills required to perform his/her job duties. Shows the ability to be flexible in an environment of constant change and is willing to mentor and train complex systems to pertinent staff.

• Takes initiative and seeks opportunities for increased learning, education, and training experience with the intent to stay informed of changes in the field of managed care as well as the objectives of this department.

• Actively participates in providing constructive feedback and ideas for new development of system and or operations.

• Provides input to leadership relative to system issues and reports inconsistencies effectively.

Qualifications

The expertise and experiences you’ll need to succeed:

KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED:

• EPIC Certified in Resolute Hospital Billing Expected Reimbursement Contracts Administration

• Knowledge and background in hospital patient accounting

• Displays ambitious standards of professional excellence.

• High degree of competency in contract language review and interpretation

• Demonstrates a strong ability to identify, analyze and solve problems.

• Effectively manages competing priorities.

• Responds effectively to tough questions and opposing views.

• Strong organizational skills while possessing the quality of knowing what must be done.

• Communicates effectively both horizontally and vertically.

• Solid experience in using Microsoft Outlook, Word, Excel, PowerPoint

KNOWLEDGE AND EXPERIENCE PREFERRED:

• Knowledge of governmental payer functions, regulations and payment methodologies and structure of Medicare, state Medicaid, Tricare and other government payers.

• CPT/HCPC coding knowledge

EDUCATION AND EXPERIENCE REQUIRED:

High School Grad or Equivalent and 4 years experience

EDUCATION AND EXPERIENCE:

REQUIRED:

• Four to five years of experience in managed care, hospital revenue cycle/patient financial services or healthcare insurance /provider relations related background.

PREFERRED :

• Bachelor's degree in business or healthcare administration or related field

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

The 3 “Must Have” Competencies/Skills

1. Epic Resolute HB Expected Reimbursement Contracts Administration certification/accreditation or the attainment of accreditation within 3 months of sitting for AdventHealth paid Epic training.

2. Other hospital contract build experience

3. Hospital billing/patient accounts experience primarily in Medicare and/or Medicaid

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: 24031607

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.