Skilled in building, maintaining and testing in complex contract management systems with a high degree of accuracy.
Responsible for the accuracy of the information in the Contract Management database which serves as an informational tool for hospital departments including Directors, CFO’s and VP’s.
Ensures appropriate documentation for record keeping of contracts and correspondence by Contract Administration for tracking and historical purposes.
Oversees the work performed to ensure the Perceptive Content system for assigned contracts is properly and accurately maintained for documentation and historical purposes.
Takes a lead role in managing projects such as the development of new systems, processes and operations. Gives input, leadership and guidance to system programmers and other key personnel.
Ensures projects stay on course through delegated assignment and effective leadership of staff.
Identifies and communicates system limitations in order to streamline and maximize utilization. Initiates tickets with AdventHealth IS or program developers as appropriate for system fixes or needed enhancements.
Provides the necessary feedback regarding system failures or inefficiencies so that the operational function of contracts and labor performance is not compromised.
Is a key player in high level Joint Operation Committee meeting discussions with regional PFS departments, variance and denial operations teams and Payers in order to resolve open AR and operational contract issues while actively contributing to the provider payer relationships.
Responsible for engaging in communication with Physician Enterprise leaders
to keep them informed of any concerns related to managed care reimbursement and operational contract issues.
Ensures key stakeholders are aware of any payer policy updates, operational changes, and governmental initiatives that may have a direct or indirect impact on physician contract operations or contract terms and rates. Guides and directs facilities on processes based on this communication.
Initiates and participates in internal and external meetings with the purpose to resolve issues, collaborate, strategize and provide feedback for developing action plans for current or future revenue opportunities.
Effectively communicates with department Directors, CFO’s, and Vice President regarding major payer issues that could have significant impact; either financially or operationally.
Takes a lead role in the collaboration and communication with outside vendors hired to facilitate the organization in certain initiatives including but not limited to account audits, system development, integrated partnership etc.
Required to play an active role in the development of new Contract Management systems as well as other products, policies and procedures that would impact the Managed Care team relative to processes and workflows.
Support and Liaison-15%
Establishes annual goals and expectations for the Contract Management team and performs annual evaluations.
Leads and directs the work of others.
Provides feedback to Contract Negotiators and staff regarding relevant contract provisions and rate application.
Responsible for supporting and assisting the various regional PE departments in Florida and Multi-state, the variance team and Managed Care staff regarding the daily operations impacted by payer contracts.
Takes the lead role in special projects and tasks as requested by leadership.
Reviews payer policies for applicability to AdventHealth contracts. Reviews any applicable national contract language to facilitate in the creation of a standard corporate position statement regarding potential dispute.
Shares in the lead responsibilities of ensuring that escalated payer issues are effectively tracked, monitored and acted upon by the Managed Care issue owner.
Serves as liaison between department and various AdventHealth Regions by providing continual education, support and training for the application of contracts as needed.
Participates in corporate discussions and gives guidance to organization regarding the implementation and operation of state and federal reimbursement changes that cause impact to Managed Care payers.
Responsible for analyzing payer information and payment trends reported by the variance team to determine impact on physician revenue and operations.
Initiates communication of pertinent information to key personnel within the organization for strategic decision opportunity.
Keeps physician negotiators informed of any major payer changes that may contradict contract language.
Ensures, through interaction with Contract Negotiators, that payer process and policy changes are evaluated for appropriateness and then effectively communicated to those who will be impacted.
Reports issues and effectively communicates with Contract Negotiators, Director of Physician Contracting, impacted physician department leadership and payers while working on solutions in order to limit the impact on the revenue stream.
Manages and ensures that proprietary contract information is handled consistently by all physician departments.
Ensure staff members have the access, equipment, data and materials necessary to perform all functions of their job.
Development, Education and Training-10%
Maintains Epic Certification (CPE) Continuing Professional Education.
Oversees the Epic Content Management process to ensure accuracy by assigned team member.
Identifies any deficiency in skill, knowledge, or performance level for any supervised staff member and provides adequate training opportunities as necessary.
Provides regular feedback to promote professional growth and learning and
completes performance appraisals in accordance with hospital policy.
Maintains adequate knowledge and proficiency of duties in order to assist, train, and when necessary fill in for supervised staff and the Director of Contract Administration.
Displays a willingness to grow and develop skills required to perform his/her job duties and assist in the training and education of team members.
Takes the initiative to seek out education and training experience to stay informed of changes in the field of Managed Care, Government, Workers Comp and any other department objectives.
Deadlines, Timeliness and Performance Standards-10%
Completes assigned tasks in the appropriate time period and maintains an acceptable work pace.
Assumes the leadership role in group situations and effectively gives directives to staff members.
Contributes to the overall completion of work product according to the applicable directive and deadline.
Motivates and empowers staff to be their best everyday while maintaining balance between empowerment and effective leadership.
Remains adaptive to new situations and is flexible in changing priorities in order to accomplish department goals.
Adheres to and enforces applicable internal policies, procedures and guidelines set forth by AdventHealth. Abides by all applicable rules, regulations and laws prescribed by any authoritative governing body such as state regulations, AHCA, CMS, etc.
What You Will Need:
Bachelor’s degree or five to seven years of experience in Healthcare and contract administration including experience in leading others.
Knowledge and Skills Required:
Ability to think analytically
Interpret data and financial reports
Navigate through various software systems
Read and understand contracts effectively
Convert complex contract language into system outputs for accurate collection activities by AdventHealth/PFS Departments
Review internal and external operations to find ways to streamline business activities
Work independently in the absence of supervision
Present and articulate ideas in a concise manner
Communicate clearly and concisely, both orally and in writing
Effective team builder with strong leadership qualities
Effectively uses organizational and planning skills with attention to detail and follow through
Maintain current knowledge, skill and abilities in contract management practices and technologies
This position is responsible for managing the AdventHealth Florida and Multi-state Physician Contract Administration team. This team is responsible for contract review; as well as, the building and maintenance of rates and terms into designated contract management systems for physician and ancillary contracts within AdventHealth Florida and Multi-state Divisions. This position carries responsibilities which have direct impact on the revenue cycle of AdventHealth. Precision of the contract build ensures payer accountability and compliance to the negotiated contract rates and terms.
This position provides guidance and direction to department leadership within Patient Financial Services (PFS), Physician Practice leadership and Managed Care staff regarding contract interpretation and the implementation and operation of language, policy and procedures including state and federal regulation. Enforces contract compliance and accountability and ensures adherence to the terms of the agreements by all parties. Evaluates trends in data in order to report accurate outcomes and communicate opportunities for improvement, resolve and growth. Encompasses outstanding customer service skills and is responsible for building and maintaining positive relationships with both internal and external customers.
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.