Senior Payer Manager Managed Care

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.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

900 HOPE WAY

City:

ALTAMONTE SPRINGS

State:

Florida

Postal Code:

32714

Job Description:

Stays updated on regulatory changes to ensure compliance with industry standards. Manages payer information to ensure accurate and timely reimbursement. Addresses systematic issues to improve operational efficiency. Details audit and error findings to support corrective actions. Develops systems to enhance operational capabilities and efficiency. Manages service tickets to ensure timely resolution of issues. Troubleshoots issues to minimize disruptions and maintain system performance. Implements contracts to ensure compliance with terms and conditions. Understands reimbursement methodologies to optimize revenue cycle management. Updates government and non-contracted rates quarterly, annually, and on an interim basis to ensure accurate billing. Prepares high-level analytic information for Revenue Cycle leadership to support strategic decision-making. Collaborates with Contract Administration, Revenue Cycle stakeholders, and Finance on government and state contracts to ensure alignment and compliance. Supports Managed Care Contract Administration, Central Denials team, and Regional PFS departments in resolving operational, accounts receivable, billing, and related issues. Maintains Epic Certification to ensure proficiency in system use. Manages the Data Courier process to facilitate data transfer and integration. Maintains fee schedules to ensure accurate billing and reimbursement. Handles rate component data to support financial analysis and reporting. Mentors staff to enhance their skills and knowledge. Conducts system audits to ensure compliance and identify areas for improvement. Supports the growth and development of the Payer Manager in both the Epic system and workflows. Other duties as assigned.

Schedule/Shift: Full-Time M/W/Th onsite in Maitland, FL 8a-5p or Fully Remote if not local within a 55-mile radius to office location

Knowledge, Skills, and Abilities:

• Microsoft Office [Required]
• Strong analytical and problem-solving skills [Required]
• Highly organized and efficient with time and resources [Required]
• Ability to manage and summarize data in a meaningful way [Required]
• Ability to lead and coordinate projects in circumstances of ambiguity and uncertainty [Required]
• Detail oriented [Required]
• Ability to prioritize and multi-task in a fast-paced environment [Required]
• Excellent interpersonal and strong verbal and written communication skills [Required]
• Professional, respectful and courteous [Required]
• Knowledge of governmental payer functions, regulations and payment methodologies and structure of Medicare, state Medicaid, Tricare and other government payers. [Preferred]
• Patient Accounting knowledge [Preferred]
• CPT/HCPC coding knowledge [Preferred]

Education:

• Associates [Required]
• Bachelor's [Preferred]

Work Experience:

• 5+years in managed care, hospital revenue cycle, payer/provider relations. [Required]

Licenses and Certifications:

• Epic Resolute Hospital Billing Charging (EPIC RHBC) [Preferred]

Physical Requirements: (Please click the link below to view work requirements)
Physical Requirements – https://tinyurl.com/23km2677

Pay Range:

$60,756.80 – $113,006.40

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse:
https://info.flclearinghouse.com/

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