Job Description
Position Overview:
This is a newly created leadership role supporting AdventHealth's Managed Care team. The Medical Economics Manager will lead a team of 3 Senior Analysts (with expected growth) and focus on maximizing reimbursement from managed care contracts.
This is an investigative, audit-style position responsible for identifying reimbursement opportunities, analyzing claims data, interpreting contract language, and determining why payments may not align with contractual expectations.
The ideal candidate understands healthcare reimbursement, managed care contracts, commercial insurance, revenue cycle operations, and financial analysis.
Day-to-Day Responsibilities
Review managed care contracts and reimbursement methodologies
Analyze claims paid below expected reimbursement levels
Investigate payment variances and root causes
Partner with Revenue Cycle, Billing, Collections, Registration, Negotiation, and Modeling teams
Audit claims and reimbursement practices
Review system data and reporting outputs
Ensure compliance with payer requirements and reimbursement standards
Lead and develop a team of Senior Analysts
Identify opportunities to maximize reimbursement revenue
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Required Skills & Experience
Must Haves:
5 years of healthcare reimbursement/financial contract analysis experience
Strong Managed Care contracting experience
Commercial Insurance Experience
Commercial payer reimbursement experience required
Medicare/Medicaid alone will NOT work
Experience with:
Revenue cycle
Billing
Claims Analysis
Revenue Integrity
Contract compliance
Reimbursement Auditing
Leadership Experience
Open to candidates with oversight/lead responsibilities if reimbursement background is strong
Bachelor's Degree
Strong Excel Skills
Nice to Have Skills & Experience
Plusses:
Provider-side healthcare experience
Experience with:
Epic
SQL/query writing
Access
Managed care negotiation experience
Experience leading financial, reimbursement, or revenue integrity teams
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.