Demonstrates ability to build, maintain and test in complex contract management systems with a high degree of accuracy.
Responsible for netting down system-wide accounts receivable.
Responds to frequent inquiries from the corporate Net Revenue Accounting department to facilitate with month end net revenue calculations.
Responsible for ensuring accurate patient estimation by providing direction to external vendor or through internal reimbursement calculations.
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.
Represents self and this organization in a professional and courteous manner and aligns self with the mission of AdventHealth so that every interaction is a true representation of our organization’s goals and values.
Supports and serves as liaison between Florida Regional PFS departments, payers, co-workers, Case Management, ancillaries, various hospital departments and leadership relative to continued education and the resolve of operational issues.
Chairs quarterly Joint Operation Committee meetings consisting of key revenue cycle stakeholders, including but not limited to, medical directors, utilization management leaders and equivalent representatives from the health plan.
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 other organizational 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.
Remains current with all pertinent payer information and is responsible for sharing and educating hospital leadership and Ancillaries as appropriate. Ensures contract information is maintained in an organized manner and facilitates in the compliance of consistency of departmental operations.
Maintain Epic Certification (CPE) – Continuing Professional Education
Demonstrates a desire to grow and develop new skills required to perform his/her job duties. Shows the ability to be flexible in an environment of constant change and is willing to assist in the training and education of team members.
What You Will Need:
Education and Experience Required:
High School Diploma
4+ years of healthcare, hospital revenue cycle or payer/provider relations experience
Bachelor degree preferred
Epic experience preferred
Knowledge and Skills Required:
High degree of competency in contract language interpretation
Ability to problem solve and think analytically
Strong organizational skills
Effectively communicate with all department levels
Ability to grow strong relationships
This position is responsible for contract review and interpretation; as well as, the building and maintenance of rates and terms into designated 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 assists the Sr. Contract Manager with ensuring that preferred contract language provides for ease of interpretation and system adjudication. Provides guidance and direction to PFS, Central Denials, Patient Access 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.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.