Director of Compliance - Managed Care

AdventHealth CorporateAll the benefits and perks you need for you and your family:Benefits from Day OneCareer DevelopmentWhole Person Wellbeing ResourcesMental Health Resources and SupportOur 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-FridayJob Location : Hybrid - Maitland, FLThe role youll 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 reports to the Executive Director of Reimbursement and Compliance.Experience in all aspects of contract dispute resolution, arbitrations, and negotiations.The value youll bring to the team:Possesses a strong understanding of the healthcare industry and payor-provider reimbursement methodologies and contract language.Maintains an extensive knowledge and library of state regulations related to insurance and managed care regulations in all states where AdventHealth has a presence.Maintains working knowledge of federal regulations and required contract language.Provides litigation support to include research necessary to build the architecture of a case, ESI and other document production during discovery, hiring of experts, coordinating depositions, and participation in any trial or hearing.Audits existing Managed Care agreements for payer compliance with terms, timely rate increases and revenue maximization to include identification of non-favorable contract payment terms.Experience with using, managing, and interpreting large amounts of healthcare data.Deploys superior analytical skills in the development and use of focused datasets to assist in dispute resolution proceedings and preparing damage estimates.Accurately gather, synthesize, and analyze relevant information to support decision making and dispute resolution strategy development.Proactively inform leadership of trends and pending changes that may impact the financial position or viability of a dispute resolution proceeding.Facilitate Arbitration hearings with support from senior leadership and legal team.Prepares documentation and participates in joint operating committee meetings with payers, revenue cycle/ denial committees, and the Contract Violations committee meetings.QualificationsThe expertise and experiences youll need to succeed:KNOWLEDGE AND EXPERIENCE STRONGLY PREFERRED: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 platformsStrong skills in analytical/problem solvingMust 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 toolsKNOWLEDGE AND EXPERIENCE PREFERRED:SQL language preferredKnowledge of Access, EPIC, Cerner, Axiom, HPM, Power BI preferred Knowledge of standard health care metrics for payer and provider reporting preferredEDUCATION AND EXPERIENCE REQUIRED:Bachelors or 10 years experience5 years Leadership ExperienceEDUCATION AND EXPERIENCE REQUIRED:Bachelor's degree, or other degree with not less than 10 years of experience in managed care, patient financial services, healthcare reimbursement, accounting and contract management.5 years of management experience required.EDUCATION AND EXPERIENCE PREFERRED:CPA or MBA preferred15 years of experience preferredSUPERVISORY RESPONSIBILITIESSupervise staff of Senior Compliance Analysts that support audits, revenue maximization and dispute resolution processes.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: ComplianceOrganization: AdventHealth CorporateSchedule: Full-timeShift: 1 - DayReq ID: 24005536We 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.

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