Operations Reimbursement Analyst - Managed Care - Maitland
Florida Hospital Careers - Maitland, FL

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Operations Reimbursement Analyst - Managed Care - Maitland

Florida Hospital's Managed Care department seeks to hire a Operations Reimbursement Analyst who will embrace our mission to extend the healing ministry of Christ.

Facility Profile:
Established in 1908, Florida Hospital is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources. The Trickel Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style café and quaint chapel. The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.

Work hours / Shifts:
Full Time - Monday-Friday - 8:00am-5:00pm

General Summary:
Responsible for analyzing Managed Care, Managed Medicare, and government payer account reconciliation discrepancies. Responsible for performing audit functions as necessary for the performance of Operations account review and Patient Financial Services (PFS) collection/reconciliation. Maintains strong working relationships with PFS, and other departments and provides direction to AHS hospitals in order to promote consistent operations. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

Knowledge, Skills, Education and Experience Required:
  • Typing: 35wpm
  • Word processing and spreadsheet experience
  • Ability to think analytically
  • Able to conduct research
  • Detail oriented
  • Minimum of two years experience in healthcare or insurance
  • Experience with Windows Applications: Microsoft Word, Excel, PowerPoint, Access, Outlook, and Ingenix Rate Manager (Preferred)
  • Experience with DOS Applications: Series/AS400, PCON, Denials Appeal and Analysis, Cerner, Trendstar, Host, 3M Outpatient Grouper, Mediregs, Paper Vision, ImageNow (Preferred)
  • Specific training or experience in managed care, patient financial services, or provider relations (Preferred)
  • Bachelors degree in related field, i.e., business, healthcare, marketing (Preferred)

Job Responsibilities:
Demonstrates through behavior Florida Hospital's core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork.
  • Systems . Works within contract management systems to determine correct reimbursement and contractual adjustments and verifies accounts as appropriate per Medicare and Managed Care guidelines. Performs account audit functions as necessary for the performance of Operations account review and Patient Financial Services (PFS) collection/reconciliation. Maintains a current level of knowledge regarding Medicare Regulatory updates/changes published by CMS to maximize reimbursement. Utilizes special skill and knowledge of multiple regional databases such as Series, PCON, DAA and Cerner.
  • Communication . Schedules and coordinates meetings and discussions with regional PFS departments as necessary in regard to the reconciliation of managed care patient accounts. Communicates with regional leadership and corporate staff in regard to system, operation, and performance issues. Effectively communicates with staff, leadership, payers, providers and visitors. Clearly and successfully represents self and this organization in a professional, courteous manner. Participates in meetings as assigned or requested. Deals with patient information in a sensitive manner to ensure respect and privacy for patient and expeditious handling of related issues.
  • Support . Supports regional AHS PFS and Managed Care departments, co-workers, and leadership in the goal of maximizing expected reimbursement through the review of Managed Care and Managed Medicare payment variances. Assists in the evaluation of both system and operational issues at the local and regional level. Supports the overall mission of Florida Hospital and the role of the Managed Care department in that mission. Demonstrates an eagerness to assist co-workers in the completion of tasks as needed. Performs special projects and tasks as requested by senior staff and leadership.
  • Liaison . Serves as liaison to Director of Managed Care and PFS Directors at the AHS regional facilities by providing instruction/guidance for payment reconciliation and contract intent. Educates regional PFS and Managed Care departments on opportunities to streamline daily work flow. Provides an intricate level of expertise relating to payer reimbursement based on state statutes and federal law.
  • Information . Responsible for researching calculation discrepancies from contract management systems to include PCON, 3M and Mediregs. Develops reports to assist regional AHS PFS Directors, Managed Care Directors and Registration Administration in identifying operational issues and trending payer performance. Identifies loading inaccuracies at the payer level.
  • Development, Education, and Training . Displays a willingness to grow and develop skills required to perform his/her job duties and assist in the training and education of team members. Takes the initiative to seek out education and training in the field of Managed Care, Managed Medicare, Managed Medicaid, Florida auto and the objectives of the department. Facilitates in the education and training of Managed Care Coordinators at the AHS Regional facilities. Develops training materials for all Managed Care Operations Departments at the AHS Regional facilities to incorporate best practices for the organization.
  • Deadlines and Timeliness . Completes assigned tasks in the appropriate time period. Maintains an acceptable work pace. In group situations, effectively contributes to the overall completion of work product according to the applicable directive and deadline. Does not interfere with the ability of co-workers to complete their duties. Readily able to adapt to new situations and changing priorities in order to accomplish department goals.
  • Performance Standards . Adheres to applicable internal policies, procedures, and guidelines set forth by Adventist Health Systems, its associated hospitals, physician groups, PHOs, and ancillaries during the execution of assigned duties. Abides by all applicable rules, regulations, and laws prescribed by any authoritative governing body such as the State of Florida, AHCA, etc

If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Operations Reimbursement Analyst job opportunity with Florida Hospital's Managed Care department and apply online today!

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