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Reimbursement Analyst Managed Care in Maitland, FL at AdventHealth

Date Posted: 2/28/2019

Job Snapshot

  • Job Schedule
    Full-Time
  • Location:
    Maitland, FL
  • Job Category
  • Date Posted:
    2/28/2019
  • Job ID:
    18015745
  • Job Function
    Managed Care
  • Travel
    No
  • Shift
    1 - Day
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Corporate

Job Description


Description

Reimbursement 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:

  • 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.

Qualifications
What You Will Need:
  • 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
  • Proficient in use of payment variance software
Job Summary:

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. 




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

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