Compliance Manager Managed Care at AdventHealth

Date Posted: 9/24/2021


Job Snapshot

  • Job Schedule
  • Location:
    Maitland, FL
  • Date Posted:
  • Job ID:
  • Job Family
    Managed Care
  • Shift
    1 - Day

Job Description


Compliance Manager AdventHealth Corporate

Location Address: 1051 Winderley Place Suite 400 Maitland, FL 32751

Top Reasons To Work At AdventHealth Corporate

  • Great benefits
  • Immediate Health Insurance Coverage
  • Career growth and advancement potential

Work Hours/Shift:

  • Full-Time, Monday - Friday

You Will Be Responsible For:

  • Possesses a wide range of knowledge and skill in managed care and revenue cycle operations to effectively lead and guide projects of compliance senior analysts and teams responsible for pulling complex information for legal actions.
  • Skilled in research of regulatory requirements, interpreting complex reimbursement methodologies, and reviewing provider/facility contract language.
  • Ensures appropriate documentation of the processes to be followed before and after the filing of an arbitration / lawsuit.  Maintain current training manual for the Compliance team.
  • Coordinate and manage data production to ensure arbitration/lawsuit Scheduling Order deadlines are met.
  • Extensively reviews and evaluates staff work product to ensure that it is created in accordance with the arbitration filing and any orders by the arbitrator/judge. 
  • Maintains separate and secure, organized structure and location for reports/data produced during arbitration to ensure and maintain data integrity.
  • Leads in researching potential contract violations added to the payor issue log and preparing documentation for Director and Senior Executive review. 
  • Initiates meeting discussions with regional PFS departments, Case Management, Denial Management, and AIT to facilitate obtaining arbitration related information necessary for the discovery process.
  • Participates in internal and external meetings with the purpose to review issues, collaborate, strategize, and provide feedback to develop current or future arbitrations / lawsuits.
  • Collaborates and communicates with outside consultants hired to facilitate the arbitration/lawsuit process through expert testimony and reports.
  • Coordinates with Reimbursement Manager to ensure timely provision of arbitration related data, damages calculations and other reports.
  • Effectively communicates to leadership regarding major payer issues that could have significant impact to hospital either financially or operationally.
  • Performs contract language review and interpretation as requested to minimize risk and maximize revenue. Ensures language meets the operational and financial needs of AdventHealth.
  • Responsible for supporting and assisting the regional Managed Care Directors and negotiators with ongoing negotiation of payer contracts through timely response to contract review requests.
  • Reviews any applicable national contract language to facilitate in the creation of a standard corporate position statement regarding potential dispute.
  • Participates in corporate discussions and gives guidance to organization regarding the implementation and operation of major CMS and AHCA requirements relative to Managed Care payers.
  • Adheres to and enforces applicable internal policies, procedures and guidelines set forth by AdventHealth. Abides by all applicable rules, regulations and laws prescribed by any authoritative governing body such as the State of Florida, AHCA, CMS, etc.
  • Supervises the Managed Care compliance team.

What You Will Need:

  • Bachelor’s Degree and 5+ years of experience
  • 5 – 7 years of experience in Healthcare and contract administration including two or more years of experience in a management level position
  • JD, CPA, or Master’s degree in Business Administration, Healthcare Administration or related field, preferred
  • Seven to ten years of specific training and/or extensive experience in Managed Care, Patient Financial Services or Provider Relations, preferred
  • EPIC Revenue Cycle Certification (or successfully complete certification within 90 days of hire)

Job Summary:

        This position will directly oversee the AdventHealth Florida and Multi-state Division Compliance team which is primarily responsible for the coordination of arbitrations/lawsuits and other compliance projects.  This position will plan, direct, and coordinate arbitration discovery to ensure scheduled deadlines are met.  Serves as a point of contact for internal departments and external parties to coordinate the legal process and produce required information and documentation. Performs quality control checks on all information produced for the arbitrations/lawsuit process.  This position will audit existing contract provisions to maximize net revenue and identify incremental net revenue opportunities.  Provides final contract review and interpretation to internal departments and through active negotiation.  Develops and maintains a strong working relationship with AH Managed Care Patient Financial Services (PFS), CDS, HIM, Utilization Management, Information Technology, other internal departments, and external Counsel in order to ensure compliance with arbitration requirements and deadlines.  This position has extensive knowledge in Managed Care contracting, revenue cycle operations, complex reimbursement methodologies and Federal and State contract requirements.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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