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Claims Examiner
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Sr. Physician Contract Analyst - Roseville, United States - Adventist Health
Description
Job DescriptionLocated in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary:
Maintains a system-wide contracting database system including cataloging, standardizing, measuring performance and ensuring regulatory compliance.
Interfaces with executive management and acts in an advisory capacity regarding contractual and compliance requirements, client specifications, government regulations and auditing associated with physician compensation, practice acquisitions and contractual obligations.
Serves as a point of contact with internal and external parties in relation to provider contract management, compliance and issues.
Makes decisions that are responsible for the success or failure of business operations and is involved in planning long or short term objectives.
Independent judgment is required, outside of making basic choices in the selection and application of established methods.Job Requirements:
Education and Work Experience:
Associate's/Technical Degree or equivalent combination of education/related experience: Required Bachelor's Degree: Preferred Five years' relevant experience: Required Contracting and broad based general finance experience:
Preferred Essential Functions:
Works with Adventist Health's hospital leadership regarding drafting new physician contracts, hospital-based group arrangements, amendments and renewals that are consistent with Adventist Health's contracting policy.
Oversees an organized effort to lead regular meetings and conversations with stakeholders through each transaction including hospital leaders and physicians.
Has advanced knowledge and experience in understanding compliance and legal requirements of contracting including Stark and Anti-Kickback.Submits contracts through Adventist Health's database and ensures process integrity to gather and review all necessary documentation, submission for legal review, and obtaining signatures.
Interface with legal team, hospital leaders and physicians. Mantains contract standards and consistency. Makes decisions that have moderate to major impact on functional operations and financial feasibility. Finds areas where improvement is needed, making recommendations, organization of goals and planning, and follow through. Participates in audits from internal departments and outside agencies.Supports the contracting and compensation database for all existing agreements and provides communication for all changes with financial and/or budgetary impact to all appropriate internal/external stakeholders.
Works on activities of a diverse scope requiring interpretation of policies and guidelines.Demonstrates understanding of techniques, processes, procedures to perform the job and seeks to complete tasks in creative and effective ways.
Cross trains with other teams such as data analytics, provider compensation, provider HR relations, & physician recruitment in order to collaborate on processes and projects.
Key point person for collecting, organizing and validating submission of fair market value analysis related to physician transactions. Provides additional analysis and reports for AH leadership, Board of Directors, Clinic Financials, System-wide Clinic Budgets and provider productivity. Ensures analysis are meeting Adventist Health standards. 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 UsAdventist Health is a faith-based, nonprofit, integrated health system serving more than 90 communities on the West Coast and Hawaii with over 400 sites of care, including 26 acute care facilities, clinics, home care, and hospice agencies in both rural and urban communities.
Our compassionate and talented team of 37,000 includes employees, physicians and volunteers driven in pursuit of one mission:living God's love by inspiring health, wholeness and hope.
