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Payer Manager Managed Care Specialist

2 months ago

Maitland, Florida, United States AdventHealth Full time
About the Role

We are seeking a highly skilled Payer Manager Managed Care professional to join our team at AdventHealth. As a key member of our revenue cycle team, you will play a critical role in ensuring the accuracy and integrity of reimbursement calculations and contract term management for our providers.

Key Responsibilities
  • Interpret and analyze payer contract terms, reimbursement schedules, and payment policies to ensure accurate reimbursement calculations.
  • Develop and maintain complex reimbursement structures using Epic Hospital Contract Management.
  • Collaborate with revenue cycle stakeholders, finance, and contract management teams to ensure seamless communication and data exchange.
  • Provide expert guidance to regional directors and managed care staff on technical system and application issues, product builds, and calculation discrepancies.
  • Produce reports and analyze data to ensure high accuracy of rate calculation components.
Requirements
  • Four to five years of experience in managed care, hospital revenue cycle, or patient financial services.
  • Epic Resolute HB Expected Reimbursement Contracts Administration certification or accreditation.
  • Strong knowledge of hospital billing, patient accounts, and government payer functions, regulations, and payment methodologies.
  • Excellent analytical, problem-solving, and communication skills.
What We Offer

As a Payer Manager Managed Care professional at AdventHealth, you will have the opportunity to work with a talented team of healthcare professionals, develop your skills and expertise, and contribute to the success of our organization.