AdventHealth

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.

Shift : Monday-Friday

Job Location : Hybrid - In office 3 days a week - Altamonte Springs, FL

The role you’ll contribute:

This position is responsible for negotiation support with top-tier payer contracts as well as direct and indirect negotiation, review, and completion of assigned mid-level and low-level tier payer contracts. Duties as assigned include assisting in strategic managed care contracting initiatives as directed by AHS leadership; managed care contract review, interpretation and analysis, negotiation, reporting, implementation for assigned low-level and mid-level tier payer contracts; and issue resolution across multiple entities including hospitals and/or physician practices in Florida as well as ancillary service providers owned, employed, or operated by AHS. This position may be called to lead strategic managed care contracting initiatives for individual provider entities. Facilitates compliance of contract terms for assigned payers by leading in strong working relationships with department staff, various hospital and provider staff, and leadership at all AHS-Florida regions, ancillaries, and external managed care payers. Actively participations in outstanding customer service and serves as a primary liaison for maintained relationships that are equally respectful of all. Diligently assists with the business relationship and advances AHS strategic and tactical objectives with each assigned payer.

The value you’ll bring to the team:

NEGOTIATION-15%

Represents Adventist Health System as lead negotiator for assigned mid-level and low-level tier and single case agreements. Facilitating contract negotiations with AHS business divisions to further AHS strategic, tactical, and operational goals.

Shows an understanding of managed care contract language related through interpretation of both operational provisions.

· SYSTEMS (5%)

Exhibits aptitude in conducting research using applicable reports (e.g. financial statements, impact analyses, database systems, etc.) to effectively contribute to contract negotiation and issue resolution.

· REGIONAL REPRESENTATION (15%)

Assists the strategy development and implementation of assigned AHS providers by serving as a managed care liaison to help advance the initiatives of those providers within the overall scope of AHS managed care strategy.

Promotes strong relationships between assigned health plans and AHS providers

· DEADLINES AND TIMELINESS (15%)

Achieves effective performance by displaying frequent self-directed and highly motivated levels of activity contributing to a satisfactory work pace with minimal direct supervision.

· COMMUNICATION (10%)

Effectively communicates with coworkers, leadership, AHS as well as outside business unit leaders, and health plans through verbal and written messages establishing a clear, professional, and courteous position on behalf of AHS.

Assists in the facilitation of communication between leadership across AHS providers as applicable by sharing contracting strategy and initiatives for the purpose of streamlining operational performance throughout AHS.

· SUPPORT (10%)

Effectively supports managed care teams and AHS provider departments to identify, quantify, and resolve financial and operational issues related to accounts receivable, utilization management, quality assurance, billing, pre-access, care management, and other related issues through ongoing regular job duties and special projects.

Contributes to the financial goals and viability of the organization and its business units by contracting appropriate rates and terms in accordance with AHS directives and market standards for the overall financial success of AHS providers.

· PERFORMANCE STANDARDS (10%)

· DEVELOPMENT, EDUCATION AND TRAINING (15%)

Contributes to the professional growth and development of others by or participating in managed care training and education sessions to continually improve the effectiveness of the Managed Care department.

Participates in industry advocacy groups (e.g. Florida Hospital Association) by contributing to requests for information or participation to support legislation and policy for healthcare providers as it relates to managed care.

Qualifications

The expertise and experiences you’ll need to succeed:

KNOWLEDGE AND SKILLS REQUIRED:

· Understands the basic functions of a large integrated healthcare system.

· Understands key elements of a contract as well as negotiation practices and processes

· Can develop, implement, and execute research plans

· Strong organizational skills

· Self-motivated with the flexibility to multitask and restructure priorities in a fast-paced environment

· Professional attitude and conduct

· Typing: 35 wpm

· Word processing, spreadsheet (Excel), and database proficiency (Epic)

· Proficiency with email, computer calendar, and web-based meetings and resources

· Excellent communication skills, both verbal and written

EDUCATION AND EXPERIENCE REQUIRED:

· Bachelor’s Degree in healthcare, finance, communications, business, or similar, or equivalent work experience- (2 years of experience for every one year of school)

· Five or more years’ experience in healthcare or insurance

· Minimum of three years training or experience in contract negotiations and/or contract administration and implementation

EDUCATION AND EXPERIENCE PREFERRED:

· One- to three years’ experience working with a large, multi-hospital integrated delivery healthcare system

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Managed Care

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 24015293

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.