AdventHealth University

Senior Payer Manager Managed Care

AdventHealth University$60K — $111K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • 5+ years in managed care, hospital revenue cycle, or payer/provider relations.
  • Associate's degree required; Bachelor's preferred.
  • Proficiency in Microsoft Office.
  • Strong analytical and problem-solving skills.
  • Knowledge of governmental payer functions and regulations preferred.
  • Detail-oriented with excellent organizational skills.
  • Epic Certification is preferred.

Responsibilities

  • Stay updated on regulatory changes for industry compliance.
  • Manage payer information for accurate reimbursements.
  • Address systematic issues to enhance operational efficiency.
  • Detail audit findings to support corrective actions.
  • Develop systems to improve operational capabilities.
  • Manage service tickets for prompt resolution of issues.
  • Prepare analytical reports for Revenue Cycle leadership.

Benefits

  • Full-Time schedule with options for remote work within 55 miles of Maitland, FL.
  • Mentorship opportunities for staff development.
  • Collaborative environment with Contract Administration and Finance stakeholders.
  • Focus on enhancing operational efficiencies and compliance.
  • Involvement in strategic decision-making processes for revenue cycle management.
Full Job Description
Stays updated on regulatory changes to ensure compliance with industry standards. Manages payer information to ensure accurate and timely reimbursement. Addresses systematic issues to improve operational efficiency. Details audit and error findings to support corrective actions. Develops systems to enhance operational capabilities and efficiency. Manages service tickets to ensure timely resolution of issues. Troubleshoots issues to minimize disruptions and maintain system performance. Implements contracts to ensure compliance with terms and conditions. Understands reimbursement methodologies to optimize revenue cycle management. Updates government and non-contracted rates quarterly, annually, and on an interim basis to ensure accurate billing. Prepares high-level analytic information for Revenue Cycle leadership to support strategic decision-making. Collaborates with Contract Administration, Revenue Cycle stakeholders, and Finance on government and state contracts to ensure alignment and compliance. Supports Managed Care Contract Administration, Central Denials team, and Regional PFS departments in resolving operational, accounts receivable, billing, and related issues. Maintains Epic Certification to ensure proficiency in system use. Manages the Data Courier process to facilitate data transfer and integration. Maintains fee schedules to ensure accurate billing and reimbursement. Handles rate component data to support financial analysis and reporting. Mentors staff to enhance their skills and knowledge. Conducts system audits to ensure compliance and identify areas for improvement. Supports the growth and development of the Payer Manager in both the Epic system and workflows. Other duties as assigned. Schedule/Shift: Full-Time M/W/Th onsite in Maitland, FL 8a-5p or Fully Remote if not local within a 55-mile radius to office location Knowledge, Skills, and Abilities: Microsoft Office [Required] Strong analytical and problem-solving skills [Required] Highly organized and efficient with time and resources [Required] Ability to manage and summarize data in a meaningful way [Required] Ability to lead and coordinate projects in circumstances of ambiguity and uncertainty [Required] Detail oriented [Required] Ability to prioritize and multi-task in a fast-paced environment [Required] Excellent interpersonal and strong verbal and written communication skills [Required] Professional, respectful and courteous [Required] Knowledge of governmental payer functions, regulations and payment methodologies and structure of Medicare, state Medicaid, Tricare and other government payers. [Preferred] Patient Accounting knowledge [Preferred] CPT/HCPC coding knowledge [Preferred] Education: Associates [Required] Bachelor's [Preferred] Work Experience: 5+years in managed care, hospital revenue cycle, payer/provider relations. [Required] Licenses and Certifications: Epic Resolute Hospital Billing Charging (EPIC RHBC) [Preferred] Physical Requirements: (Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/23km2677 Pay Range: $60,151.66 - $111,886.39

About AdventHealth University

AdventHealth University is a private university in Orlando, Florida. It was founded in 1992 and is affiliated with the Seventh-day Adventist Church. The university offers undergraduate and graduate degree programs in various fields including nursing, radiography, and sonography. AdventHealth University is accredited by the Southern Association of Colleges and Schools Commission on Colleges.
Learn more about AdventHealth University
Size
1,000 employees
Industry

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