Reimbursement Analyst Managed Care Remote

AdventHealth • Altamonte Springs, FL

418d • Remote

About The Position

The Reimbursement Analyst for Managed Care at AdventHealth is responsible for ensuring timely and accurate loading of providers with Managed Care contracted payers. This role involves evaluating professional fee contractual adjustments for accuracy, supporting payment variance identification, and collaborating with various teams to recommend corrective actions on payment variances and provider profiles.

Requirements

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

Nice To Haves

• Bachelor's Degree in healthcare, business administration or related field.
• System experience in identifying payment variances (Athena/Epic).
• Experience in claim denial follow-up with payers.

Responsibilities

• Ensure timely and accurate loading of providers with Managed Care contracted payers.
• Evaluate professional fee contractual adjustments for accuracy according to payer contracts and federally mandated guidelines.
• Support payment variance identification for the Physician Enterprise (PE).
• Collaborate with practice office operations staff, Managed Care contracting, Credentialing and Enrollment, and billing support teams to identify and recommend corrective actions on payment variances.
• Submit delegated and nondelegated credentialing reports after completion of credentialing and enrollment tasks.
• Confirm accuracy and timeliness of provider information entered into payer systems and directories.
• Enter effective date and provider number information into Athena/Epic and MSOW Network Management to release held claims and update status reports.
• Review and resolve claim denials related to credentialing and enrollment status of providers.
• Identify payment variances for professional fee commercial contracts and government payers, reviewing reports to determine true variances based on reimbursement guidelines.
• Liaise with payers to request provider profile updates and negotiate discounts as directed by management.
• Maintain knowledge of current rules and regulations of Commercial and Government programs.
• Review contractual adjustments to determine causes and categorize variance types for management review.
• Serve as a subject matter resource for payment variance identification and education.
• Meet with PE and MC to update provider load, variance projects, and specific payer issues.
• Analyze data to provide insights on payer reimbursement trends and load accuracy for provider profiles.
• Coordinate with billing support teams on identified payment variances and credentialing denials.
• Complete special projects as assigned by the reimbursement manager.

Benefits

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

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: High school or GED