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. Its 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, Full time, 8am-5pm hybrid (Monday, Wednesday, Thursday on site)
Job Location : Maitland, FL
The role you will contribute:
A Medical Economics Manager is responsible for overseeing the analysis and evaluation of financial and economic data related to healthcare costs and managed care payer rates and reimbursement. The role focuses on financial trends, reimbursement methodology, data tools, modeling, managing revenue, and managing and mentoring of director reports. Must be able to complete extensive and complex financial, operational, and analysis of managed care contracts, proposals, analyze fee schedules, and determine contract compliance. The Medical Economics Manager must have attention to detail and competencies in decision support and reporting through converting raw data as well as for creating meaningful applications to support executive decision making. Character traits to include: Strong work ethic, communicative, team player, strong analytic skills, and strong organizational skills. The Medical Economics Manager will manage and mentor managed care staff for both the Florida and Multi-State Divisions of AdventHealth, as well as represent AdventHealth managed care to payers in all AdventHealth Markets.
The value you will bring to the team:
Leads complex Medical economic projects related to Value Based Contract Modeling. Accountabilities include project initiations, identification and completion of key deliverables to ensure all business objectives are met Leads Research and analyzes managed care data from the various financial systems and interface tools Responsible for review of analysis of complex and varied healthcare data including financial modeling and risk forecasting Identify and/or implement improvements in quality control/timeliness of reporting Manage extracts, collects, analysis and interpretations of health utilization and financial data of various @types Interpret an analyze data from various sources using knowledge of healthcare managed care contracts and healthcare administrative claims data Reviews existing complex models and implements them on new projects and/or new @contexts and she/he designs new solutions for data and analytic challenges the organization faces Assisting in the negotiations of capitated and other VBA agreements between physicians/hospitals and payers/networks through detailed data analytics by provide accurate finance models Identify risk/exposure associated with various reimbursement structures. Produce prospective analyses an new venture, products, and service offerings Prepare and effectively present analytics or project results to key stakeholders for review and decision-making Performs analysis of complex and varied healthcare data including financial modeling and risk forecasting Evaluate and understand contract language as it relates to reimbursement methodologies Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II, DRG and revenue codes Proficient with various reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators Oversees the both standard and Ad-hoc reports, analytical modeling, and consulting on provider specific negotiations in the Florida and Multi-State AdventHealth regions Accumulates data in logical format, interprets results, makes recommendations and influences outcomes Prepares well-organized project-specific documentation, that includes at a minimum, analytic methods used, ley decision points and caveats with sufficient detail to support comprehension and replication Leads in the development and review of the annual Managed care net revenue budgets to support the annual AdventhHealth Budget process Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance Demonstrates independent thinking and creativity in development of contract models, standard reports and ad hoc analyses Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by leadership Evaluates performance of immediate subordinates and makes recommendations for personnel actions. Screens, interviews, and hires qualified applicants for open positions. Performs personnel management activities, including merit increases, promotions, transfers, and disciplinary actions. Determines training and development programs for support staff and arranges such opportunities. Maintain a working knowledge of current rules and regulations of Commercial and Government programs. Mentors direct reports Develops Others through recognizes colleagues strengths and development opportunities and provides them with ongoing feedback and coaching Knows the Business and understands how the business works and can identify sources of value, efficiency, and effectiveness Manages Quality and Risk and understands and applies quality assurance and risk management procedures in all areas of work performed Identifies and solves problems using data collection methods, analysis, experience, and judgment Possesses deep knowledge and specialized skill set pertaining to the job function Maintains a high degree of accuracy while using large amounts of data Complete special projects and performs other duties as assigned
Leads complex Medical economic projects related to Value Based Contract Modeling.
Accountabilities include project initiations, identification and completion of key deliverables to ensure all business objectives are met
Leads Research and analyzes managed care data from the various financial systems and interface tools
Responsible for review of analysis of complex and varied healthcare data including financial modeling and risk forecasting
Identify and/or implement improvements in quality control/timeliness of reporting
Manage extracts, collects, analysis and interpretations of health utilization and financial data of various @types
Interpret an analyze data from various sources using knowledge of healthcare managed care contracts and healthcare administrative claims data
Reviews existing complex models and implements them on new projects and/or new @contexts and she/he designs new solutions for data and analytic challenges the organization faces
Assisting in the negotiations of capitated and other VBA agreements between physicians/hospitals and payers/networks through detailed data analytics by provide accurate finance models
Identify risk/exposure associated with various reimbursement structures. Produce prospective analyses an new venture, products, and service offerings
Prepare and effectively present analytics or project results to key stakeholders for review and decision-making
Performs analysis of complex and varied healthcare data including financial modeling and risk forecasting
Evaluate and understand contract language as it relates to reimbursement methodologies
Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II, DRG and revenue codes
Proficient with various reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge
Recommends contractual payment term changes that achieve net revenue targets developed by the Regional Managed Care Directors and Contract negotiators
Oversees the both standard and Ad-hoc reports, analytical modeling, and consulting on provider specific negotiations in the Florida and Multi-State AdventHealth regions
Accumulates data in logical format, interprets results, makes recommendations and influences outcomes
Prepares well-organized project-specific documentation, that includes at a minimum, analytic methods used, ley decision points and caveats with sufficient detail to support comprehension and replication
Leads in the development and review of the annual Managed care net revenue budgets to support the annual AdventhHealth Budget process
Evaluates actual contract performance against expected; analyzes data to distinguish patterns and recognize trends in contract performance
Demonstrates independent thinking and creativity in development of contract models, standard reports and ad hoc analyses
Manages and completes multiple projects in a fast-paced environment within timeframes outlined in the department policies and as specified by leadership
Evaluates performance of immediate subordinates and makes recommendations for personnel actions.
Screens, interviews, and hires qualified applicants for open positions.
Performs personnel management activities, including merit increases, promotions, transfers, and disciplinary actions.
Determines training and development programs for support staff and arranges such opportunities.
Maintain a working knowledge of current rules and regulations of Commercial and Government programs.
Mentors direct reports
Develops Others through recognizes colleagues strengths and development opportunities and provides them with ongoing feedback and coaching
Knows the Business and understands how the business works and can identify sources of value, efficiency, and effectiveness
Manages Quality and Risk and understands and applies quality assurance and risk management procedures in all areas of work performed
Identifies and solves problems using data collection methods, analysis, experience, and judgment
Possesses deep knowledge and specialized skill set pertaining to the job function
Maintains a high degree of accuracy while using large amounts of data
Complete special projects and performs other duties as assigned
Qualifications
The expertise and experiences you'll need to succeed:
Bachelor's degree in Finance, Health Care Administration, Accounting, Mathematics, or Health and Informatics or related field
Master's Degree in a related field Required
Epic HB Certification Required
6 years experience performing data, financial and/or risk analytics in a healthcare environment Required
4 years of managerial experience Required
Working knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation
Working knowledge of healthcare claims for all provider @types
Managed Care, Patient Financial services, health insurance claims processing, contract management, or medical economics experience
Proficiency in understanding professional and facility claims and managed care concepts such as risk adjustment, capitation, FFS, DRG, APG, APCs and other payment mechanisms
Experience in modeling financial impact of changes and presenting the findings with Senior Leadership
Strong ability to handle multiple projects including problem solving, research, analysis, and communication in a fast-paced environment
In depth knowledge of Commercial and Government programs reimbursement rules and regulations
Intermediate level of proficiency working with MS Excel including Formulas, calculations, charts, and graphs
Strong skills in analytical/problem solving and presentations
Excellent interpersonal skills
Ability to complete assigned tasks with very limited supervision
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: Accounting/Finance
Organization: AdventHealth Corporate
Schedule: Full-time
Shift: 1 - Day
Req ID: 25028410
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.
