Job Description
Adventist Health is ranked #10 in Becker’s list of the largest nonprofit hospital systems in the U.S. We are the largest company headquartered and sixth largest employer in Roseville, California. Our corporate headquarters have been located at a desirable location on Douglas Boulevard since 1984. To accommodate our growing services, we are creating a new campus that will not only bring our workforce of nearly 900 people together in one location, but also facilitate a deeper connection with our Roseville neighbors and community.
Job Summary:
Assists with managed care contracting activities on behalf of the organization. Assists departmental leadership to maximize contract reimbursements from third party payer agreements. Participates in the development, communication and implementation of financial and operational requirements of third party payer agreements.
Job Requirements:
Education and Work Experience:
- Associate’s/Technical Degree or equivalent combination of education/related experience: Required
- Bachelor’s Degree: Preferred
Essential Functions:
- Assists with Analyzing financial and operational data related to managed care contracts for the organization. Assists with researching managed care contract language and methodologies. Reviews, analyzes and monitors contracts while ensuring legal and compliance policies and regulations are followed and met.
- Acts as a liaison for the efficient communication and coordination of day-to-day managed care operational issues related to patient access, claims adjudication and collection, and medical care management.
- Analyzes coding interprets reimbursement. Researches for trends of variances and contacts payers to recover underpayments. Maintains systems and tracks variance statistics. Works with internal stakeholders and external payer representatives to ensure contract compliance and resolution of payment issues.
- Creates and maintains detailed reports for management. Analyzes current payers’ contracts for areas of improvement during contract negotiation.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.
About Us
Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good – from the operating room to the boardroom, we are driven by our unique passion to live God’s love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.