[Remote] Analyst Reimbursement Managed Care - Remote

Note: The job is a remote job and is open to candidates in USA. AdventHealth is a community-focused organization dedicated to uplifting individuals in body, mind, and spirit. They are seeking an Analyst Reimbursement Managed Care who will utilize strong analytical and problem-solving skills to address complex issues related to reimbursement and credentialing.

Responsibilities

• Demonstrated strong analytical reasoning, critical thinking, judgment, and problem-solving skills in order to independently assess, interpret, and address complex issues in a continually changing environment
• Demonstrated strong computer software skills including Microsoft Office applications, with a proficiency in Microsoft Excel and the ability to work with and manipulate data within Reports, Formulas, Charts, and Pivot Tables
• Submits credentialing reports accurately and timely
• Confirms provider information on credentialing applications and reports
• Enters effective date and provider number information from payers into relevant systems
• Reviews and resolves claim denials related to credentialing and enrollment status
• Identifies and analyzes payment variances for professional fee contracts and government payers
• Reviews reports to determine true variances based on reimbursement guidelines and contracted fee schedules
• Liaises with payers to address issues and ensure accurate processing
• Works closely with Managed Care contract administration to ensure accurate provider profiles
• Maintains knowledge of current rules and regulations of Commercial and Government programs
• Aggregates and categorizes variance types for management review
• Serves as a resource for payment variance identification and education
• Coordinates with billing support teams on identified payment variances and credentialing denials
• Other duties as assigned

Skills

• Bachelor's, High School Grad or Equiv (Required)
• Demonstrated strong analytical reasoning, critical thinking, judgment, and problem-solving skills in order to independently assess, interpret, and address complex issues in a continually changing environment
• Demonstrated strong computer software skills including Microsoft Office applications, with a proficiency in Microsoft Excel and the ability to work with and manipulate data within Reports, Formulas, Charts, and Pivot Tables
• Submits credentialing reports accurately and timely
• Confirms provider information on credentialing applications and reports
• Enters effective date and provider number information from payers into relevant systems
• Reviews and resolves claim denials related to credentialing and enrollment status
• Identifies and analyzes payment variances for professional fee contracts and government payers
• Reviews reports to determine true variances based on reimbursement guidelines and contracted fee schedules
• Liaises with payers to address issues and ensure accurate processing
• Works closely with Managed Care contract administration to ensure accurate provider profiles
• Maintains knowledge of current rules and regulations of Commercial and Government programs
• Aggregates and categorizes variance types for management review
• Serves as a resource for payment variance identification and education
• Coordinates with billing support teams on identified payment variances and credentialing denials
• Other duties as assigned

Benefits

• Medical, Dental, Vision Insurance
• Life Insurance
• Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Company Overview