Director of Compliance Managed Care at AdventHealth Greater Orlando

Maitland, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

17 Feb, 26

Salary

0.0

Posted On

19 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Leadership, Analytical Skills, Communication Skills, Project Management, Healthcare Data Management, Contract Negotiation, Regulatory Knowledge, Litigation Support, Team Management, Problem Solving, Technical Skills, Microsoft Office, SQL, Healthcare Metrics, Compliance Auditing, Inter-Company Relationships

Industry

Hospitals and Health Care

Description

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 Full time 8am-5pm Job Location: Maitland, FL The role you will contribute: This position will be responsible for execution of the managed care payor dispute resolution processes for all AdventHealth providers in all markets. This will include developing the architecture and theory of potential litigation or arbitration, estimating and compiling damages calculations, researching and analyzing market data in support of potential dispute resolution, and negotiating during settlement and arbitration processes. The position will collaborate across a matrixed team of revenue cycle, finance, and administrative resources to support the dispute resolution processes. The position will also oversee the team of Sr. Compliance Analysts and Compliance Analysts to monitor their work on their respective Arbitrations and Litigations they are assigned too. The position reports to the Executive Director of Reimbursement and Compliance. This position will be responsible for execution of the managed care payor dispute resolution processes for all AdventHealth providers in all markets. This will include developing the architecture and theory of potential litigation or arbitration, estimating and compiling damages calculations, researching and analyzing market data in support of potential dispute resolution, and negotiating during settlement and arbitration processes. The position will collaborate across a matrixed team of revenue cycle, finance, and administrative resources to support the dispute resolution processes. The position will also oversee the team of Sr. Compliance Analysts and Compliance Analysts to monitor their work on their respective Arbitrations and Litigations they are assigned too. The position reports to the Executive Director of Reimbursement and Compliance. The value you will bring to the team: Manages and interprets large amounts of healthcare data. Deploys analytical skills to develop and use focused datasets for dispute resolution and damage estimates. Gathers, synthesizes, and analyzes relevant information to support decision making and dispute resolution strategy. Manages contract dispute resolution, arbitrations, and negotiations. Understands healthcare industry and payor-provider reimbursement methodologies and contract language. Maintains extensive knowledge of state regulations related to insurance and managed care. Keeps working knowledge of federal regulations and required contract language. Provides litigation support, including research, ESI, document production, hiring experts, coordinating depositions, and participating in trials or hearings. Audits Managed Care agreements for payer compliance, timely rate increases, and revenue maximization. Identifies non-favorable contract payment terms. Informs leadership of trends and pending changes impacting financial positions or dispute resolution viability. Prepares documentation and participates in joint operating committee meetings with payers, revenue cycle/denial committees, and Contract Violations committee meetings. Manages and oversees the team of Compliance Analysts and Sr. Compliance Analysts. Conducts contract reviews and redlining as well as reviewing and redlining settlement documentation. Other duties as assigned. The expertise and experiences you’ll need to succeed: · Bachelor’s Degree · 5+ years leadership experience · Ability to deliver time-pressured projects on-time and with the desired results through a structured project management (time, team, work-stream management) approach. · Excellent written and oral communication skills. · Ability to work in a matrix environment and manage a large number of matters simultaneously. · Fosters strong inter-company relationships that facilitate cross functional monitoring of payor issues. · Self-directed with a strong bias for action. · Demonstrated leadership and/or people management skills. · Ability to work in various software platforms · Strong skills in analytical/problem solving · Must possess strong technical skills in Microsoft Office Applications (Excel, Access, Word, PowerPoint) as well as experience using analytical/reporting applications such as Business Objects or other BI tools Preferred Qualifications: · Master’s Degree · SQL language · Knowledge of Access, EPIC, Cerner, Axiom, HPM, Power BI · Knowledge of standard health care metrics for payer and provider reporting · Certified Public Accountant (CPA)

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Responsibilities

The Director of Compliance Managed Care will execute managed care payor dispute resolution processes for AdventHealth providers, including developing litigation strategies and negotiating settlements. This role involves collaboration with various teams and oversight of compliance analysts.