Senior Compliance Analyst

Our 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.All the benefits and perks you need for you and your family: Benefits from Day One: 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 Schedule:Full timeShift:Day (United States of America)Address:2600 LUCIEN WAYCity:MAITLANDState:FloridaPostal Code:32751Job Description:Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by Leadership and adapts to new situations and changing priorities to accomplish project deadlines and department goals. Maintains a high degree of accuracy while using large amounts of data by applying technical expertise in the development of analysis, models, and decision support information with the ability to demonstrate excellent data gathering, independent thinking, decision making, problem solving and reporting skills; excellent follow through. Serves as process and content expert by demonstrating a thorough understanding of reimbursement methodologies and their impact on internal systems and other departments with a willingness to contribute to the overall completion of the work product in group project situations and maintains and utilizes available resources to ensure work is completed accurately and timely. Other duties as assigned. Analyze, understand, and articulate regulatory and contractual requirements and apply identified requirements to business operations. Facilitate resolution to contract violations by leveraging knowledge of state Insurance and Managed Care laws and state reporting requirements for HMO/Insurance companies. Facilitate resolution to contract violations by leveraging knowledge of Medicaid and Medicare Advantage contract requirements, regulations, and federal and state specific appeal processes. Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines that impact healthcare billing and reimbursement and applies significant understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG and revenue codes. Supports Managed Care leadership in contract negotiations through detailed scenario modeling, comparative analysis, and benchmarking. Evaluates and understands contractual language related to reimbursement methodologies. Demonstrates proficiency with various reimbursement methodologies including, Per Diem, DRG, fee schedules, and percent of charge and also demonstrates extensive knowledge of both commercial and governmental payers for modeling and analyzing contract proposals. Audit current contracts for potential revenue opportunities and contract violations for all payer types. Calculate and manage damages spreadsheets throughout any settlement, mediation, arbitration or lawsuits. Manage payor legal action through research, damages calculations, and organizing data/materials from other AdventHealth departments (i.e. medical records, itemized bills, etc.) within the scheduled timeframes. Maintain and report contract violations by payor, hospital, and AH Division to include related financial impact. Performs contract language review in accordance with state statutes, federal regulation and AdventHealth Managed Care policy.Knowledge, Skills, and Abilities:• The Senior Compliance Analyst role requires extensive knowledge in Managed Care contract interpretation and payment methodologies, billing, and coding for all types of healthcare entities (hospital, physician, ancillaries, etc.). [Required]• Ability to use data systems, and contract management software applications, clinical information and other information generated by numerous sources to identify opportunities to improve contract reimbursement performance or identify compliance issues. [Required]• Proficiency in performing data and contract analytics; ability to effectively apply analytical and quantitative skills in reviewing payer reimbursement performance. [Required]• Effective oral and written communication skills with the ability to articulate complex information in understandable terms to all levels of staff. [Required]• Must have advanced proficiency with Microsoft Excel, Access, Power Point, and Word. [Required]• Must demonstrate an ability and willingness to learn and adapt to a changing reimbursement environment. [Required]• Ability to conduct oneself professionally, maintain confidence, confidentiality and objectivity. [Required]• Must work with minimal supervision and efficiently manage multiple work streams and analyses.Education:• Bachelor's Degree [Required]• Master's [Preferred]Field of Study:• N/AWork Experience:• 3+ years of experience in Healthcare, Managed Care, Hospital or Ancillary claims analysis, Hospital or Ancillary claims payment, or related field [Required]• 5+ years in Managed Care, Managed Care finance, contract management, or health insurance claims processing [Preferred]Additional Information:• An equivalent combination of education and relevant work experience may be considered in lieu of the stated degree requirement: Bachelor’s degree AND 3+ years of experience OR Associate’s degree AND 5+ years of experience OR High School Grad or Equiv AND 7+ years of experience Licenses and Certifications:• EPIC-Resolute Hospital Billing Expected Reimbursement Contracts Administration (EPIC-RHBERCA) [Preferred]• Certified Public Accountant (CPA) [Preferred]• EPIC-Resolute Professional Billing Administration (EPIC-RPBA) [Preferred]Physical Requirements: (Please click the link below to view work requirements)Physical Requirements - Pay Range:$66,170.74 - $123,073.07This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.Category: Revenue Cycle & Managed CareOrganization: AdventHealth CorporateSchedule: Full timeShift: DayReq ID: 151156665

Created: 2026-03-10