Maintain team training calendar and training room reservations
Review and update new team member training materials as needed
Prepare new team member training materials
Provide back up support for new hire training
Conduct new team member post training continuing education
Create and maintain job aids and training collateral for the team
Ensure team members have appropriate system accesses
Review ongoing audits for outstanding education opportunities
Create and conduct approved continuing education classes
Assist with remediation education with team supervisors
IT/IS Systems Support
Assist with ordering training materials, new team member training supplies, creating and tracking IT tickets for new team member access
Create minutes for any IT technical, functional, or enhancement meetings and track action items
Identification of IT and process issues, and collaboration with Denial Management leaders to implement required solutions
Participates in meetings and discussions with Denial Management Executive Director, Denial Management Manager(s) and Denial Management Supervisors relative to training methods and educational goals for best practices for AdventHealth.
Assists management staff in disseminating procedural changes and system updates promptly.
Identifies system loading discrepancies within the contract management system and refers to the Supervisor for investigation.
Maintains thorough understanding of managed care payment methodologies. This includes interpreting multiple payment methodologies for payer types such as Commercial Managed Care, Managed Medicare, Managed Medicaid and other governmental payers based on state statues and federal law.
Researches and/or stays informed of changes in the field of Managed Care, Managed Medicare, Managed Medicaid and Tricare, and the objectives of the department to provide additional educational opportunities to the staff as needed.
Can identify payer performance trends by identifying loading inaccuracies at the payer level.
Maintains knowledge of payer financial contract terms and conditions.
Readily able to adapt to new situations and changing priorities in order to accomplish department goals.
Strives towards meeting quality expectations to align performance with assigned roles and responsibilities. Escalates concerns or difficulties in meeting performance expectations in a timely manner for management action.
Maintains a positive working relationship with internal staff and external providers and payer representatives and acts in a professional, courteous manner always.
Performs other duties as assigned by management.
Adheres to applicable internal policies, procedures, and guidelines set forth by AdventHealth, its associated hospitals, physician groups, PHOs, and ancillaries during the execution of assigned duties.
Abides by all applicable rules, regulations, and laws prescribed by any authoritative governing body such as the State of Florida, AHCA, etc.
Deals with patient information in a sensitive manner to ensure respect and privacy for patient and expeditious handling of related issues.
Supports the overall mission of AdventHealth and the role of the Denial Management Department in that mission.
What You Will Need:
High school diploma or equivalent
5+ years’ experience in Revenue Cycle
1+ year experience in Denial Management
Experience in education and/or employee training on receivables software systems
KNOWLEDGE AND SKILLS REQUIRED:
Experience in healthcare claims processing and proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms
Technical proficiency within Patient Accounting systems and denial management workflow technology; position requires ability to navigate various modules within applicable technologies to perform account research
Experience leading group instruction/presentations
Thorough understanding of an explanation of benefits (EOB)/remits, including the corresponding claim adjustment reason codes and remittance advice remark codes
Basic knowledge of ICD-10, CPT and HCPCS coding standards
Strong organizational skills
Strong keyboard and 10 key skills
Proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook, OneNote, Teams and Visio
Ability to communicate effectively in written and oral form with diverse populations
Interpersonal skills to promote teamwork throughout the Denials Management team
Ability to multitask and function in a fast-paced environment
Ability to prioritize and problem-solve
Self-motivated and able to work with multiple and multi-functional teams
Work within very tight time frames
Under general supervision of the Denials Management Manager, the Performance Analyst contributes to enhancing the performance of the Denial Management team through education and training, collateral and documentation development, and IT/IS systems support. The Performance Analyst provides outstanding customer service to the department through respectful relationships and support. The Performance Analyst assists with initiatives that promote efficient and effective processes and support the ongoing excellence of the team.
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.