🌎
This job posting isn't available in all website languages

Reimbursement Analyst

📁
Other Non-Clinical Professional
💼
Adventist Health System Corporate Office

If you want to be a part of a place that provides nothing less than extraordinary compassionate care, then Adventist Health System is the place for you!

We are currently seeking qualified candidates for a Reimbursement Analyst position that will be based in our Managed Care department. This position is based in Maitland, FL.

Responsible for evaluating professional fee contractual adjustments for accuracy in accordance with various payer contracts and/or federally mandated guidelines. This position supports the payment variance identification for the Physician Enterprise (PE) and works closely with practice office operations staff, Managed Care (MC) contracting and billing support teams to identify and recommend corrective action on payment variances.

Specific job duties include:




  • Responsible for identifying payment variances for professional fee commercial contracts and government payers. Reviews reports generated by Athena and/or PED to determine of the variances listed in the report, which are the true variances (under/overpayments) based on reimbursement guidelines from past billing/payer experience, payer websites, government updates, contracted fee schedules, etc.
  • Liaisons with payer as directed by management to request payment and/or within given guidelines, negotiates/approves discount.
  • Closely works with MC contract administration and keeps open dialogue to ensure loaded contracts are accurate and updated as directed by management.
  • Maintains a working knowledge of current rules and regulations of Commercial and Government programs.
  • Reviews contractual adjustments to determine cause, aggregates and categorizes variances types in organized manner for management review.
  • Serve as Adventist Health System’s subject matter resource for Commercial and Government payment variance identification, and education.
  • Meets with PE and MC as directed by management to update current variance projects and specific payer issues.
  • Analyzes data to provide payer reimbursement trends
  • Coordinates with billing support teams as directed by management on identified payment variances.
  • Completes special projects as assigned by the reimbursement manager within the time frame requested.


Knowledge and Skills Requirements:




  • In depth knowledge of Commercial and Government program reimbursement rules and regulations
  • Ability to research and interpret Commercial and Government payer rules and regulations
  • Proficient in use of payment variance software
  • Possess an understanding of variance reimbursement methodologies, auditing principles and their application to healthcare
  • Strong computer software skills including Microsoft Office applications
  • Ability to learn new technology applications used by Adventist Health System
  • Strong analytical reasoning, critical thinking, judgment and problem solving skills in order to independently assess, interpret and address complex issues in a continually changing environment
  • Excellent interpersonal skills
  • Well organized and detail-oriented
  • Ability to complete assigned tasks with limited supervision
  • System experience in identifying payment variances (Athena) (Preferred)


Education Requirements:

  • AA Degree
  • Bachelor’s Degree in healthcare, business administration or related field (Preferred)


Experience Requirements:

  • Minimum of 3 years of relevant experience in healthcare reimbursement including Commercial and Government payers


Attributes:

  • Achieves results: Reflects a drive to achieve and outperform, continuously looking for improvements, and accepts responsibility for actions and results
  • Builds and Shares Knowledge: Develops and shares subject matter expertise/reusable assets that can be readily applied to new tasks
  • Communication Skills: Exhibits excellent oral and written communication skills
  • Critical Thinking: Methodically analyzes and evaluates business problems by defining the challenges, identifying alternatives, and making timely decisions
  • Develops Self: Understands own strengths and development needs, learns from experience, and owns personal development
  • Knows the Business: Understands how the business works and can identify sources of value, efficiency, and effectiveness
  • Manages and Executes Projects: Manages all aspects of engagement/project to ensure outcomes and timing are met
  • Manages Quality and Risk: Understands and applies quality assurance and risk management procedures in all areas of work performed
  • Problem Solving: Identifies and solves problems using data collection methods, analysis, experience, and judgment
  • Subject Matter Expertise: Possesses deep knowledge and specialized skill set pertaining to the job function


If this position sounds like a great match for your skills set and experience, please apply online now!

Activity Feed

25473
Job shares through Adventist Health System
Someone applied to the Transporter - Transportation –Altamonte – Part Time position. 12 hours ago
Someone applied to the SCHEDULER position. 18 hours ago
Someone applied to the Medical Receptionist @ Tuscawilla Family Practice cc4390 position. 1 day ago

Similar Listings

Adventist Health System Corporate Office

Florida, Maitland

📁 Other Non-Clinical Professional

Adventist Health System Corporate Office

Florida, Maitland

📁 Other Non-Clinical Professional

Florida Hospital Medical Group

Florida, Maitland

📁 Other Non-Clinical Professional