Managed Care Coordinator

Adventist Health • Maitland, FL

79d

About The Position

The Managed Care Coordinator is a responsible member of a multi-disciplinary team. S/he represents AdventHealth to payors, serving to validate that payors contractual obligation in terms of updated fee schedules and modifications to contracts. S/he must manage the contracts, therefore, must have a high degree of understanding of the requirements of each Agreement for all hospital, ancillary, and physician services. In addition, s/he must communicate regularly with clinical and support staff in order to obtain the optimum reimbursement, decrease operational overhead, and maximize patient benefits.

Requirements

• 3+ years of managed care or position-related experience.
• General knowledge of healthcare, hospital and provider operations, and managed care payer contracts and operations.
• Must have a high degree of understanding of the managed care payers and managed care contracting requirements.
• Knowledge of healthcare, hospital/provider operations and managed care payer operations.

Nice To Haves

• Bachelor's Degree

Responsibilities

• Analyzes managed care contracts to ensure compliance with organizational standards and regulatory requirements.
• Negotiates contract terms with payors to secure favorable reimbursement rates and conditions.
• Reviews and updates fee schedules and contract modifications to reflect current rates and terms.
• Communicates contract changes and updates to relevant internal departments and stakeholders.
• Collaborates with clinical and support staff to optimize reimbursement and reduce operational overhead.
• Monitors payor compliance with contractual obligations and addresses any discrepancies.
• Maintains accurate and up-to-date records of all managed care contracts and related documentation.
• Provides training and support to staff on managed care contract requirements and changes.
• Facilitates open communication and joint decision-making with payors and internal teams.
• Builds and maintains relationships with payors to ensure effective contract management.
• Resolves any issues or conflicts related to managed care contracts in a timely manner.
• Participates in performance improvement initiatives related to managed care processes.
• Other duties as assigned.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees