Managed Care Contract Manager at AdventHealth

Date Posted: 11/2/2020

Job Snapshot

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

Job Description


Managed Care Contract 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:

  • Responsible for summarizing key contract data elements which are populated into the Managed Care database including addition of new payers, auto increases, renewals and termination.
  • Accountable for accurately reporting key contract data elements to ADVENTHEALTH Florida Division leadership and ancillary facilities.
  • Responsible for ensuring that the contract image database is maintained with current information that accurately represents contract activities.  This includes providing 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.
  • Facilitates Regional PFS departments, Case Management, Denial Management and ancillary facilities in articulating operational contract issues to the Payers and provides the forum to effectively discuss and share information between ADVENTHEALTH and payers.
  • Maintains communication and coordinates with Payer to ensure timely execution of contract rate implementation.
  • Ensures hospital staff, leadership and ancillaries are aware of any payer policy updates, operational changes, and governmental initiatives that may have a direct or indirect impact on hospital operations or contract terms and rates.  Guides and directs facilities on processes based on this communication.
  • Responsible for remaining current on regulatory changes that could impact reimbursement relative to CMS, Medicaid, Tricare and Workers Comp and effectively communicates this information with Managed Care team and leadership.
  • Extracts pertinent contract information to update database which provides reports for distribution to Senior Staff, ADVENTHEALTH Florida and Multi-State Managed Care Directors and Ancillaries.
  • Accountable for ensuring Payer updates (policy, system edits, operational changes, etc.) are appropriate and the implementation of such change is in alignment with the terms of the contract. Once determined, appropriate action taken to either educate hospital departments of upcoming changes or challenge the implementation with the payer.

What You Will Need:
  • High School Diploma or equivalent
  • Four to five years of experience in Managed Care or Patient Financial Services or healthcare Provider Relations experience.
  • Typing:35 wpm
  • Spreadsheet experience
  • Bachelor’s degree in Business or Healthcare Administration or related field, preferred
  • Five to seven years in healthcare or insurance, preferred
Job Summary:

This position is responsible for contract review and interpretation; as well as, the building and maintenance of rates and terms into multiple contract management systems for AdventHealth Florida Division and Ancillaries.  Precision of the contract build ensures payer accountability and compliance to the negotiated contract rates and terms.  This affords AdventHealth leadership the foundation for reporting and determining overall payer performance and allows AdventHealth the ability to accurately model contracts for future negotiations. The accuracy of these builds is also essential for estimating month-end net patient revenue for the Florida division.

This position consults with and assists the Contract Negotiator with preferred contract language which allows for ease of interpretation and system adjudication.  Provides guidance and direction to PFS Directors and Managed Care staff regarding contract terms and policies including; governmental initiatives, rules and regulations.  Develops and maintains a strong working relationship with AdventHealth Florida Division leadership, AdventHealth Central Denials, Regional Revenue Cycle leadership including CBO, UR, CM, Patient Access, Revenue Integrity, HIM, Ancillary facilities and other internal departments in order to ensure compliance and awareness of negotiated contract terms and rates.

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

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