Analyst Reimbursement Managed Care - Remote

OverviewJob Description - Analyst Reimbursement Managed Care - Remote (25016994)BenefitsAll the benefits and perks you need for you and your family• Benefits from Day One• Career Development• Whole Person Wellbeing Resources• Mental Health Resources and SupportOur promise to you:Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.Job Location: Monday-Friday 8:00am to 5:00pm - RemoteThe role you’ll contributeResponsibilities:Responsible for ensuring the providers are loaded timely and accurately with Managed Care contracted payers.Responsible for evaluating professional fee contractual adjustments for accuracy in accordance with various payer contracts and/or federally mandated guidelines.Support payment variance identification for the Physician Enterprise (PE) and collaborate with practice office operations staff, Managed Care (MC) contracting, MC Credentialing and Enrollment and billing support teams to identify and recommend corrective action on payment variances and provider profiles with the payers.The value you’ll bring to the team:Submits the delegated and nondelegated credentialing reports once credentialing and enrollment tasks are completed by the MC Credentialing and Enrollment Teams.Confirms providers submitted on credentialing applications and ensures delegated/nondelegated credentialing reports are entered accurately and timely into payer systems and directories.Enters effective dates and provider numbers from payers in Athena/Epic and MSOW Network Management, releasing held claims and updating the status report for practices.Reviews and resolves claim denials related to credentialing and enrollment status of AH employed providers.Identifies payment variances for professional fee commercial contracts and government payers; reviews reports to determine true variances based on guidelines and payer sources.Liaises with payers as directed to update provider profiles, payments, and negotiates/approves discounts within given guidelines.Works with MC contract administration to ensure loaded contracts and provider specialties are accurate and updated as directed by management.Maintains knowledge of current rules and regulations of Commercial and Government programs.Reviews contractual adjustments to determine cause and categorizes variance types for management review.Serves as AdventHealth’s subject matter resource for Commercial and Government payment variance identification and education.Meets with PE and MC as directed to update current provider load, variance projects and payer issues.Analyzes data to provide payer reimbursement trends, payer load times and load accuracy for provider profiles.Coordinates with billing support teams on identified payment variances and credentialing pletes special projects as assigned by the reimbursement manager within the requested time frame.QualificationsThe expertise and experiences you’ll need to succeed:High School or equivalent degree Required3+ relevant experience in healthcare reimbursement including Commercial and Government payers RequiredBachelor’s in healthcare, business administration or related field PreferredIn-depth knowledge of Commercial and Government program reimbursement rules and regulationsAbility to research and interpret payer rules and regulationsProficient in use of payment variance softwareUnderstanding of variance reimbursement methodologies, auditing principles and their application to healthcareStrong computer software skills including Microsoft Office applicationsAbility to learn new technology applications used by Adventist Health SystemStrong analytical reasoning, critical thinking, judgment and problem solving skills to independently address complex issuesExcellent interpersonal skillsWell organized and detail-orientedAbility to complete assigned tasks with limited supervisionSystem experience in identifying payment variances (Athena/Epic)Claim denial follow-up with payersOur people are passionate about what they do, the product they sell, and the customers they serve. If you/'re looking for an opportunity to be a part of a work family that values collaboration, innovation and dedication, we/'re the right company for you. #J-18808-Ljbffr

Created: 2025-09-26