Reimbursement Analyst- Managed Care

Top Reasons to Work at AdventHealth Corporate

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

• Full-Time, Monday â“ Friday

You Will Be Responsible For:

• 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 Systemâ™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.

• High school or equivalent degree
• Minimum of 3 years of relevant experience in healthcare reimbursement including Commercial and Government payers
• 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

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.