AdventHealth
Senior Compliance Analyst – AdventHealth
Senior Compliance Analyst responsible for reviewing and enforcing contract compliance, analyzing payer reimbursement methodologies, and supporting contract negotiations for AdventHealth.
Benefits & Perks
Benefits from Day One
Career Development
Whole Person Wellbeing Resources
Mental Health Resources and Support
Shift & Location Shift: Monday‑Friday 8am‑5pm hybrid (Monday, Wednesday, Thursday onsite) Location: Maitland, FL
Role Overview The Senior Compliance Analyst applies technical and analytical skills to identify, quantify, and present contract compliance violations. Performs extensive review of contract language, state and federal regulations, and payer practices to facilitate resolution of contract non‑compliance.
Contract Compliance (60%)
Performs contract language review in accordance with state statutes, federal regulation, and AdventHealth Managed Care policy.
Maintains and reports contract violations by payer, hospital, and AH Division including related financial impact.
Manages payor legal action through research, damages calculations, and organizing materials.
Calculates and manages damages spreadsheets throughout settlements, mediation, arbitration, or lawsuits.
Audits current contracts for potential revenue opportunities and contract violations.
Analyzes, understands, and articulates regulatory and contractual requirements and applies identified requirements to business operations.
Facilitates resolution of contract violations by leveraging knowledge of state insurance and managed care laws, Medicaid contract requirements, and Medicare Advantage appeal processes.
Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact healthcare billing.
Reimbursement (30%)
Supports Managed Care leadership in contract negotiations through detailed scenario modeling, comparative analysis, and benchmarking.
Evaluates and understands contractual language related to reimbursement methodologies.
Applies understanding of medical coding systems (ICD‑9/10, CPT, HCPCS II, DRG, revenue codes) to claim adjudication.
Demonstrates proficiency with reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge.
Provides extensive knowledge of commercial and governmental payers for modeling and analyzing contract proposals.
Recommends contractual payment term changes that achieve net revenue targets developed by Regional Managed Care Directors and Contract negotiators.
Support (10%)
Manages and completes multiple projects in a fast‑paced environment within specified timeframes.
Adapts to new situations and changing priorities to accomplish project deadlines and departmental goals.
Maintains high accuracy while handling large amounts of data.
Applies technical expertise in development of analysis, models, and decision support information.
Demonstrates excellent data gathering, independent thinking, decision making, problem solving, and reporting skills.
Serves as process and content expert on reimbursement methodologies and their impact on internal systems.
Contributes to completion of work product in group project situations.
Utilizes available resources to ensure timely and accurate completion of work.
Expertise & Experience Required
3 years healthcare, managed care, hospital, or ancillary claims analysis; bachelor’s degree.
5 years experience for associate degree holders.
7 years experience for high school diploma or equivalent holders.
Extensive knowledge in managed care contract interpretation, billing, coding, and payment methodologies across all healthcare entities.
Proficiency in using data systems and contract management software applications.
Advanced proficiency in Microsoft Excel, Access, PowerPoint, and Word.
Strong oral and written communication skills to articulate complex information.
Adaptability to changing reimbursement environments.
Professional conduct with confidence, confidentiality, and objectivity.
Ability to work with minimal supervision and manage multiple analyses efficiently.
Preferred Qualifications
EPIC Credential (EPIC CRED) in Resolute Hospital Billing; expected employment within three months.
Certified Public Accountant (CPA).
Master’s degree.
Equal Opportunity Employer Statement This facility is an equal opportunity employer and complies with federal, state and local anti‑discrimination laws, regulations and ordinances. We 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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Benefits & Perks
Benefits from Day One
Career Development
Whole Person Wellbeing Resources
Mental Health Resources and Support
Shift & Location Shift: Monday‑Friday 8am‑5pm hybrid (Monday, Wednesday, Thursday onsite) Location: Maitland, FL
Role Overview The Senior Compliance Analyst applies technical and analytical skills to identify, quantify, and present contract compliance violations. Performs extensive review of contract language, state and federal regulations, and payer practices to facilitate resolution of contract non‑compliance.
Contract Compliance (60%)
Performs contract language review in accordance with state statutes, federal regulation, and AdventHealth Managed Care policy.
Maintains and reports contract violations by payer, hospital, and AH Division including related financial impact.
Manages payor legal action through research, damages calculations, and organizing materials.
Calculates and manages damages spreadsheets throughout settlements, mediation, arbitration, or lawsuits.
Audits current contracts for potential revenue opportunities and contract violations.
Analyzes, understands, and articulates regulatory and contractual requirements and applies identified requirements to business operations.
Facilitates resolution of contract violations by leveraging knowledge of state insurance and managed care laws, Medicaid contract requirements, and Medicare Advantage appeal processes.
Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact healthcare billing.
Reimbursement (30%)
Supports Managed Care leadership in contract negotiations through detailed scenario modeling, comparative analysis, and benchmarking.
Evaluates and understands contractual language related to reimbursement methodologies.
Applies understanding of medical coding systems (ICD‑9/10, CPT, HCPCS II, DRG, revenue codes) to claim adjudication.
Demonstrates proficiency with reimbursement methodologies including Per Diem, DRG, fee schedules, and percent of charge.
Provides extensive knowledge of commercial and governmental payers for modeling and analyzing contract proposals.
Recommends contractual payment term changes that achieve net revenue targets developed by Regional Managed Care Directors and Contract negotiators.
Support (10%)
Manages and completes multiple projects in a fast‑paced environment within specified timeframes.
Adapts to new situations and changing priorities to accomplish project deadlines and departmental goals.
Maintains high accuracy while handling large amounts of data.
Applies technical expertise in development of analysis, models, and decision support information.
Demonstrates excellent data gathering, independent thinking, decision making, problem solving, and reporting skills.
Serves as process and content expert on reimbursement methodologies and their impact on internal systems.
Contributes to completion of work product in group project situations.
Utilizes available resources to ensure timely and accurate completion of work.
Expertise & Experience Required
3 years healthcare, managed care, hospital, or ancillary claims analysis; bachelor’s degree.
5 years experience for associate degree holders.
7 years experience for high school diploma or equivalent holders.
Extensive knowledge in managed care contract interpretation, billing, coding, and payment methodologies across all healthcare entities.
Proficiency in using data systems and contract management software applications.
Advanced proficiency in Microsoft Excel, Access, PowerPoint, and Word.
Strong oral and written communication skills to articulate complex information.
Adaptability to changing reimbursement environments.
Professional conduct with confidence, confidentiality, and objectivity.
Ability to work with minimal supervision and manage multiple analyses efficiently.
Preferred Qualifications
EPIC Credential (EPIC CRED) in Resolute Hospital Billing; expected employment within three months.
Certified Public Accountant (CPA).
Master’s degree.
Equal Opportunity Employer Statement This facility is an equal opportunity employer and complies with federal, state and local anti‑discrimination laws, regulations and ordinances. We 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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