Senior Compliance AnalystMaitland, FL

Senior Compliance Analyst

Hospitals, medical centers and facilities need more than physicians, nurses and specialists delivering care to our patients. A truly successful health care organization needs a thoughtful, dedicated, steady and experienced team working behind the scenes to make sure communities around the country receive the health care they need.

If you've also been interested in working in the health care field but aren't a health care provider, a corporate career at AdventHealth may just be the perfect fit. We're a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.

Start your journey with a health care career at AdventHealth Corporate.

Every day, our fellow team members show up to work, unified by one shared mission : Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we're committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

The role you will contribute :

The Senior Compliance Analyst applies technical, analytical, and problem-solving skills to identify, quantify, and present contract compliance violations. He / she will perform extensive review of contract language, state and federal regulations, and payor practices to facilitate resolution of contract non-compliance. This person demonstrates attention to detail and competencies in contract language review, research, decision support, and financial analysis in the preparation and support of payor arbitrations. This person is responsible for compiling and analyzing multiple sources of data to support executive decision-making regarding contract violations. The Senior Compliance Analyst will have expertise in Commercial and Governmental (Medicare, Medicaid, Tricare) payer reimbursement language and methodologies. The Senior Compliance Analyst works with Managed Care staff in all AH Divisions, as well as payers in all markets. Actively participates in outstanding customer service and maintain relationships with clients who include AH Managed Care Directors, Contract Denial Specialists, other AdventHealth departments, payers and legal counsel.

The value you will bring to the team :

Contract Compliance-60%

• Performs contract language review in accordance with state statutes, federal regulation and AdventHealth Managed Care policy.
• Maintain and report contract violations by payor, hospital, and AH Division to include related financial impact.
• Manage payor legal action through research, damages calculations, and organizing data / materials from other AdventHealth departments (i.e. medical records, itemized bills, etc.) within the scheduled timeframes.
• Calculate and manage damages spreadsheets throughout any settlement, mediation, arbitration or lawsuits.
• Audit current contracts for potential revenue opportunities and contract violations for all payer types.
• Analyze, understand, and articulate regulatory and contractual requirements and apply identified requirements to business operations.
• Facilitate resolution to contract violations by leveraging knowledge of state Insurance and Managed Care laws and state reporting requirements for HMO / Insurance companies.
• Facilitate resolution to contract violations by leveraging knowledge of Medicaid contract requirements, regulations, and state specific appeal processes.
• Facilitate resolution to contract violations by leveraging knowledge of Medicare Advantage plans regulatory requirements and Medicare Advantage Appeal processes and requirements.
• Maintain knowledge of applicable rules, regulations, policies, laws, and guidelines that impact healthcare billing.

Reimbursement-30%

Support-10%

The expertise and experiences you'll need to succeed :

Preferred Qualifications :

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.