Los Angeles, California
Posted: 23-Apr-25
Location: Maitland, Florida
Categories:
Internal Number: 25015439
All 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 Support
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.
Job Location: Monday-Friday - 8:00am-5:00pm - Onsite - Altamonte Springs, FL
The role you’ll contribute:
his position is responsible for managing the AdventHealth Multi-State Division Contract Management team. This team is responsible for contract review; as well as, the building and maintenance of rates and terms into multiple contract management systems for hospital and ancillary contracts within AdventHealth Multi-State Division. This position carries responsibilities which have direct impact on the revenue cycle of AdventHealth. Precision of the contract build ensures payer accountability and compliance to the negotiated contract rates and terms. This position provides guidance and direction to department leadership within Patient Financial Services (PFS), Utilization Management and Ancillary facilities regarding contract interpretation and the implementation and operation of language, policy and procedures including state and federal regulation. Enforces contract compliance and accountability and ensures adherence to the terms of the agreements by all parties. Evaluates trends in data in order to report accurate outcomes and communicate opportunities for improvement, resolve and growth. Encompasses outstanding customer service skills and is responsible for building and maintaining positive relationships with both internal and external customers.
The value you’ll bring to the team:
- Systems-20% * Skilled in building, maintaining and testing in complex contract management systems with a high degree of accuracy. * Responsible for the accuracy of the information in the Contract Management database which serves as an informational tool for hospital departments including Directors, CFO’s and VP’s. * Ensures appropriate documentation for record keeping of contracts and correspondence by Contract Administration for tracking and historical purposes. * Oversees the work performed to ensure the Perceptive Content system for assigned contracts is properly and accurately maintained for documentation and historical purposes. * Takes a lead role in managing projects such as the development of new systems, processes and operations. Gives input, leadership and guidance to system programmers and other key personnel. * Ensures projects stay on course through delegated assignment and effective leadership of staff. * Identifies and communicates system limitations in order to streamline and maximize utilization. Initiates tickets with AdventHealth IS or program developers as appropriate for system fixes or needed enhancements. * Provides the necessary feedback regarding system failures or inefficiencies so that the operational function of contracts and labor performance is not compromised.
- Communication-15% * Initiates and moderates high level Joint Operation Committee meeting discussions with regional PFS departments, Case Management, Denial Management, internal and external Medical Directors and Payers in order to resolve open AR and operational contract issues while managing the provider payer relationship. * Responsible for engaging in communication with hospital revenue and clinical departments * to keep them informed of any concerns related to managed care reimbursement and operational contract issues. * Ensures hospital staff, leadership and Ancillaries are aware of any payer policy updates, operational changes, and governmental initiatives that may have a direct or indirect impact on hospital operations or contract terms and rates. Guides and directs facilities on processes based on this communication. * Initiates and participates in internal and external meetings with the purpose to resolve issues, collaborate, strategize and provide feedback for developing action plans for current or future revenue opportunities. * Effectively communicates with department Directors, CFO’s, and Vice President regarding major payer issues that could have significant impact to hospital either financially or operationally. * Takes a lead role in the collaboration and communication with outside vendors hired to facilitate the organization in certain initiatives including but not limited to account audits, system development, integrated partnership etc. * Required to play an active role in the development of new Contract Management systems as well as other products, policies and procedures that would impact the Managed Care team relative to processes and workflows.
- Support and Liaison-15% * Establishes annual goals and expectations for the Contract Management team and performs annual evaluations. * Leads and directs the work of others. * Provides feedback to Contract Negotiators and staff regarding relevant contract provisions and rate application. * Responsible for supporting and assisting the various regional AdventHealth PFS departments in Multi-State, payers, coworkers, Case Management, Ancillaries, various hospital departments and leadership in the daily operations impacted by Payer contracts. * Takes the lead role in special projects and tasks as requested by leadership. * Meets with facility Directors, CFO’s, and AVP’s on a regular basis to review progress, discuss payer problems and consider necessary changes. * Reviews payer policies for applicability to AdventHealth contracts. Reviews any applicable national contract language to facilitate in the creation of a standard corporate position statement regarding potential dispute. * Shares in the lead responsibilities of ensuring that escalated payer issues are effectively tracked, monitored and acted upon by the Managed Care issue owner. * Serves as liaison between department and various AdventHealth Regions by providing continual education, support and training for the application of contracts as needed. * Participates in corporate discussions and gives guidance to organization regarding the implementation and operation of major CMS and AHCA requirements relative to Managed Care payers.
- Information-10% * Responsible for analyzing payer information and payment trends to determine impact on hospital revenue and operations. * Initiates communication of pertinent information to key personnel within the organization for strategic decision opportunity. * Keeps hospital negotiators informed of any major payer changes that may contradict contract language. * Ensures payer process and policy changes are evaluated for appropriateness and then effectively communicated to those who will be impacted. * Reports issues and effectively communicates with impacted hospital department leadership and payers while working on resolution in order to limit the impact on the revenue stream. * Manages and ensures that proprietary contract information is handled consistently by all hospital departments. * Ensure staff members have the access, equipment, data and materials necessary to perform all functions of their job.
- Development, Education and Training-10% * Identifies any deficiency in skill, knowledge, or performance level for any supervised staff member and provides adequate training opportunities as necessary. * Provides regular feedback to promote professional growth and learning and * completes performance appraisals in accordance with hospital policy. * Maintains adequate knowledge and proficiency of duties in order to assist, train, and when necessary fill in for supervised staff and the Director of Contract Administration. * 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 experience to stay informed of changes in the field of Managed Care, Government, Workers Comp and any other department objectives.
- Deadlines, Timeliness and Performance Standards-10% * Completes assigned tasks in the appropriate time period and maintains an acceptable work pace. * Assumes the leadership role in group situations and effectively gives directives to staff members. * Contributes to the overall completion of work product according to the applicable directive and deadline. * Motivates and empowers staff to be their best everyday while maintaining balance between empowerment and effective leadership. * Remains adaptive to new situations and is flexible in changing priorities in order to accomplish department goals. * Adheres to and enforces applicable internal policies, procedures and guidelines set forth by AdventHealth. Abides by all applicable rules, regulations and laws prescribed by any authoritative governing body such as the State of Multi-State, AHCA, CMS, etc.
The expertise and experiences you’ll need to succeed:
Qualifications
- High School Diploma or equivalent Required
- 5 Healthcare and contract administration Required or
- 2 management level position Required
- Bachelor's in Business Administration, Healthcare Administration or related field Preferred
- 7 specific training Preferred or
- extensive experience in Managed Care, Patient Financial Services or Provider Relations Preferred
- Detail oriented
- Ability to think analytically
- Interpret data and financial reports
- Navigate through various software systems
- Read and understand contracts effectively
- Convert complex contract language into system outputs for accurate collection activities by AdventHealth/PFS Departments
- Review internal and external operations to find ways to streamline business activities
- Work independently in the absence of supervision
- Present and articulate ideas in a concise manner
- Communicate clearly and concisely, both orally and in writing
- Effective team builder with strong leadership qualities
- Effectively uses organizational and planning skills with attention to detail and follow through
- Maintain current knowledge, skill and abilities in contract management practices and technologies
- Windows Applications:
- Microsoft Word, Excel, Power Point, Access, Outlook
Our 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.
