Contract Manager

Adventist Health • Maitland, FL

104d

About The Position

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.

Requirements

• High School Grad or Equiv Required
• 4+ of experience in managed care, patient financial services or healthcare payer relations background Required
• Detail oriented
• Assertive
• 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

Nice To Haves

• Certification in HB Resolute Epic Contract Management Preferred
• Microsoft Office
• Bachelor's Preferred
• Patient Accounting knowledge Preferred
• CPT/HCPCS coding knowledge Preferred
• 5+ in healthcare, hospital revenue cycle or payer/provider relations Preferred

Responsibilities

• 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.
• Provides the necessary feedback regarding system failures or inefficiencies.
• Facilitates Regional PFS departments, Case Management, Denial Management and ancillary facilities in articulating operational contract issues to the 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.
• Represents self and this organization in a professional and courteous manner.
• Responsible for protecting confidential patient and contract information.
• Supports and serves as liaison between Florida Regional PFS departments, payers, co-workers, Case Management, ancillaries, various hospital departments and leadership.
• Chairs quarterly Joint Operation Committee meetings consisting of key revenue cycle stakeholders.
• Demonstrates an eagerness to assist co-workers in the completion of tasks as needed.
• Performs special projects and tasks as requested by senior staff and leadership.
• Responsible for remaining current on regulatory changes that could impact reimbursement.
• Extracts pertinent contract information to update database which provides reports for distribution to Senior Staff.
• Accountable for ensuring Payer updates are appropriate and the implementation of such change is in alignment with the terms of the contract.
• Remains current with all pertinent payer information and is responsible for sharing and educating hospital leadership and Ancillaries.
• Maintain Epic Certification (CPE) – Continuing Professional Education.
• Demonstrates a desire to grow and develop new skills required to perform his/her job duties.
• Takes initiative and seeks opportunities for increased learning, education and training experience.
• Completes all tasks in the appropriate time period maintaining an acceptable work pace.

Benefits

• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support

What This Job Offers

• Education Level: High school or GED
• Number of Employees: 501-1,000 employees