Note: The job is a remote job and is open to candidates in USA. AdventHealth is a community-focused organization dedicated to uplifting individuals in body, mind, and spirit. They are seeking an Analyst Reimbursement Managed Care who will utilize strong analytical and problem-solving skills to address complex issues related to reimbursement and credentialing.
Responsibilities
- Demonstrated strong analytical reasoning, critical thinking, judgment, and problem-solving skills in order to independently assess, interpret, and address complex issues in a continually changing environment
- Demonstrated strong computer software skills including Microsoft Office applications, with a proficiency in Microsoft Excel and the ability to work with and manipulate data within Reports, Formulas, Charts, and Pivot Tables
- Submits credentialing reports accurately and timely
- Confirms provider information on credentialing applications and reports
- Enters effective date and provider number information from payers into relevant systems
- Reviews and resolves claim denials related to credentialing and enrollment status
- Identifies and analyzes payment variances for professional fee contracts and government payers
- Reviews reports to determine true variances based on reimbursement guidelines and contracted fee schedules
- Liaises with payers to address issues and ensure accurate processing
- Works closely with Managed Care contract administration to ensure accurate provider profiles
- Maintains knowledge of current rules and regulations of Commercial and Government programs
- Aggregates and categorizes variance types for management review
- Serves as a resource for payment variance identification and education
- Coordinates with billing support teams on identified payment variances and credentialing denials
- Other duties as assigned
Skills
- Bachelor's, High School Grad or Equiv (Required)
- Demonstrated strong analytical reasoning, critical thinking, judgment, and problem-solving skills in order to independently assess, interpret, and address complex issues in a continually changing environment
- Demonstrated strong computer software skills including Microsoft Office applications, with a proficiency in Microsoft Excel and the ability to work with and manipulate data within Reports, Formulas, Charts, and Pivot Tables
- Submits credentialing reports accurately and timely
- Confirms provider information on credentialing applications and reports
- Enters effective date and provider number information from payers into relevant systems
- Reviews and resolves claim denials related to credentialing and enrollment status
- Identifies and analyzes payment variances for professional fee contracts and government payers
- Reviews reports to determine true variances based on reimbursement guidelines and contracted fee schedules
- Liaises with payers to address issues and ensure accurate processing
- Works closely with Managed Care contract administration to ensure accurate provider profiles
- Maintains knowledge of current rules and regulations of Commercial and Government programs
- Aggregates and categorizes variance types for management review
- Serves as a resource for payment variance identification and education
- Coordinates with billing support teams on identified payment variances and credentialing denials
- Other duties as assigned
Benefits
- Medical, Dental, Vision Insurance
- Life Insurance
- Disability Insurance
- Paid Time Off from Day One
- 403-B Retirement Plan
- 4 Weeks 100% Paid Parental Leave
- Career Development
- Whole Person Well-being Resources
- Mental Health Resources and Support
- Pet Benefits
Company Overview
AdventHealth is a nonprofit healthcare system providing whole-person care through hospitals, clinics, and virtual services. It was founded in 1973, and is headquartered in Altamonte Springs, Florida, USA, with a workforce of 501-1000 employees. Its website is https://www.adventhealth.com/.
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