Senior Analyst Managed Care Relocation to Orlando at AdventHealth

Date Posted: 12/4/2019

Job Snapshot

  • Job Schedule
    Full-Time
  • Location:
    Miami, FL
  • Job Category
  • Date Posted:
    12/4/2019
  • Job ID:
    19017300_3
  • Job Family
    Managed Care
  • Travel
    No
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Corporate

Job Description


Description

Senior Analyst, Managed Care AdventHealth Corporate
Location Address: 900 Hope Way Altamonte Springs, Florida 32714
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:
  • Supports Managed Care leadership in contract negotiations through detailed financial modeling, comparative analysis, and benchmarking.
  • Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue codes
  • Leads in the development and review of the annual Managed Care Net Revenue budgets to support the annual AHS budget process.
  • Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance
  • Serves as process and content expert by demonstrating a thorough understanding of reimbursement methodologies and their impact on internal systems and other departments
  • Completes timely and accurate financial analyses related to Managed Care net revenue
  • Serves as process and content expert by demonstrating a thorough understanding of reimbursement methodologies and their impact on internal systems and other departments


Qualifications

What You Will Need:
  • Bachelor’s degree in Finance, Economics, Mathematics, Accounting, Statistics or related field
  • At least five years of analytic experience with emphasis in healthcare and/or clinical application and health insurance finances
  • Technical experience in utilizing analytical software tools and applications
  • Experience working with healthcare, insurance or claims data
  • Healthcare information systems (PCON, Cerner, Soarian, Athena)
  • Data warehousing tools (Access, SQL Server, etc.)
  • Knowledge of common analytical methods such as modeling payer terms, comparing actual to expected reimbursement, and detailing reimbursement by service line
  • Intermediate level of proficiency in performing data and contract analytics; ability to effectively apply analytical and quantitative skills in reviewing payer reimbursement performance.
Job Summary:
The Senior Managed Care Analyst is responsible for analytic strategies focused on Managed Care Payer Contract Performance.  Areas of focus include modeling Payer Contract terms including Fixed, Percent of Charge, Fee Schedule and Value Based Methodologies.  The Senior Managed Care Analyst engages clients (health plans, leaders and providers) in reviewing reimbursement data including but not limited to financial performance, contract compliance, denial reviews, and prospective modeling of proposed contract terms.  The Senior Managed Care Analyst will provide analyses and strategic recommendations to maximize and optimize payer reimbursement in the aggregate as well as at key service line levels.  The Senior Managed Care Analyst will have expertise in Governmental (Medicare, Medicaid, Tricare) and Commercial payer reimbursement language and methodologies.  The Senior Managed Care Analyst works with Managed Care staff in all AHS Divisions, as well as payers in all markets.  Actively participates in outstanding customer service and maintain relationships with clients who include
AHS facility controllers, accountants and Managed Care Directors



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

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