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All the benefits and perks you need for you and your family:

-          Benefits from Day One

-          Paid Days Off from Day One

-          Career Development

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.

Schedule: Full Time,  Remote but onsite first 60 days

Shift: M-F Days

The role you’ll contribute:

This position is responsible for the review, financial analysis, negotiation, billing, and collection efforts of all AdventHealth Transplant cases in the Central Florida Region. In-depth understanding of payer contracts related to the appropriateness of billing the payer directly and or globally is required. Actively participates in the contract negotiations including but not limited to market research and rate analysis for payer contracts for solid organ and bone marrow transplants. Transplant patient case billing/follow-up is done within contracted timeframes. The individual will work closely with patients, hospital staff, insurance companies, and other external organizations to ensure timely and accurate payment for transplant procedures. Responsible for knowledge of service line specifics for each Transplant Center.

The value you’ll bring to the team:

•PATIENT ACCOUNT SET UP AND MAINTENANCE-7%

· Sets up and maintains patient files for transplant accounts within expected timeframes of notice of a new patient.

· Updates and disseminates critical patient account information to internal and external customers such as Florida Institute for Cellular Therapy, Florida Hospital Transplant Institute, Cedar Gate (global billing vendor), Patient Financial Services and other treating providers.

INVOICING/BILLING PAYERS AND TRACKING PAYER REIMBURSEMENTS-10%

· Accurately assesses appropriateness of all incoming provider claims and documents in patient account.

· Resolves any payment variances directly and in a timely manner with the payer or payer network representatives.

PAYMENT PROCESSING TO GLOBAL NETWORK PROVIDERS-10%

· Validates reimbursement to providers in accordance with provider Agreements.

· Responsible to produce and review all account transaction reports.

INTERNAL AND EXTERNAL COMMUNICATION AND SUPPORT-5%

· Effectively communicates with staff, leadership, payers, providers, and, as applicable, with patients in a professional and courteous manner.

· Coordinates and leads meetings with internal partners such as other Managed Care teams, Florida Institute for Cellular Therapy, Florida Hospital Transplant Institute, Cedar Gate (global billing vendor), Patient Financial Services, Physician groups and other AdventHealth departments to provide a forum and effectively discuss and resolve issues, initiate operational improvements, and share information.

FINANCE AND ACCOUNTING-18%

· Accurately and timely closes patient accounts, balancing all revenue and expenses.

· Accurately and timely documents all information in summary sheets, spreadsheets and applicable systems.

· Manually document and post payer payments by recording provider payment checks and electronic fund transfer (EFT) in billing and accounting system. Reports information to Accounting monthly.

Initiates the Payment Authorization Voucher process with the Accounting Department.

CONTRACTS AND LETTERS OF AGREEMENT-5%

· Actively participates in provider and payer Global contracting and negotiations including research and rate analysis.

· Negotiates and prepares Letters of Agreement (LOA) with non-contracted providers, payers and employer groups.  Ensures terms of fully executed LOA’s are distributed to all pertinent parties.

SYSTEMS AND SUPPORT-20%

· Maintains all aspects of Accounts Receivable for global and direct bill payers including re-classing accounts, contractual adjustments and follow-up codes. 

· Facilitates the flow of payment from payer to provider and addresses any issues that arise.

· Initiates and directs scheduled meetings with Transplant Center physicians and administrative members to review existing and upcoming transplant cases, resolve identified issues, and identify process improvement opportunities.

· Performs Transplant account audits for team members and provides feedback and additional training to the staff as needed.

CONFIDENTIALITY-5%

· Deals discretely with confidential information concerning AdventHealth affairs and documents.  Releases confidential information only with approval from leader(s) with no exceptions.  Refrains from discussing business with those who do not have a need to know.

· Complies with corporate confidentiality procedures.

· Deals with patient information in a sensitive manner to ensure respect and privacy for patient and expedites handling of patient related issues.

The expertise and experiences you’ll need to succeed:

EDUCATION AND EXPERIENCE REQUIRED:

·    Bachelor’s degree or 4 years of transplant experience

·    Five years in healthcare or insurance

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About AdventHealth

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.

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