Location Address: 1051 Winderley Place Suite 400 Maitland, FL 32751
Top Reasons To Work At AdventHealth Corporate
Immediate Health Insurance Coverage
Career growth and advancement potential
Full-Time, Monday – Friday
You Will Be Responsible For:
Represents AdventHealth as lead negotiator for assigned top-tier and mid-level tier managed care health plans in facilitating contract negotiations with AdventHealth business divisions to further AdventHealth strategic, tactical, and operational goals.
Assumes the role of a subject matter expert during contract negotiations by displaying proficiency and distinction related to managed care and contract negotiation topics with the intention of maintaining strategic alignment with contracted health plans.
Seeks resolution to managed care issues by collecting and interpreting contract performance information (e.g. claims volumes, quality and efficiency reports, participation gap analysis, accounts receivable data, etc.) to preserve the integrity of those contracts.
Exhibits research proficiency using applicable reports (e.g. financial statements, impact analyses, database systems, etc.) to effectively lead in contract negotiation and issue resolution.
Coordinates with multiple internal teams (e.g. Contract Management, Finance, etc.) and external teams (e.g. PFS, Pre-Access, etc.) to ensure that contracting information is correct and up to date in all applicable Managed Care documentation and resources.
Assumes responsibility as a managed care liaison to assigned AdventHealth providers by leading or contributing as needed to contracting strategy development and implementation for the purposes of advancing the initiatives of those providers within the overall scope of AdventHealth managed care strategy.
Refines ongoing managed care processes by developing information and documents such as contract language and negotiation strategies for the purpose of enhancing performance standards in the Managed Care department.
What You Will Need:
Bachelor’s Degree in healthcare or related field, or equivalent work experience
Seven or more years’ experience in healthcare or insurance
Minimum of five years training or experience in contract negotiations and/or contract administration and implementation
Master’s degree in healthcare or related field, preferred
Five or more years’ experience working with multi-hospital integrated delivery healthcare system, preferred
This position is responsible for direct and indirect negotiation, review, and completion of assigned top-tier and mid-level tier payer contracts. Duties as assigned include leading strategic managed care contracting initiatives as directed by AdventHealth leadership; managed care contract review, interpretation and analysis, negotiation, reporting, implementation for assigned mid-level and top 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 AdventHealth. 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 AdventHealth Florida markets, providers, 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 manages the business relationship and advances AdventHealth strategic and tactical objectives with each assigned payer.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.