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Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better.

All the benefits and perks you need for you and your family:

+ Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

+ Paid Time Off from Day One

+ 403-B Retirement Plan

+ 4 Weeks 100% Paid Parental Leave

+ Career Development

+ Whole Person Well-being Resources

+ Mental Health Resources and Support

+ Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

900 WINDERLEY PL

City:

MAITLAND

State:

Florida

Postal Code:

32751

Job Description:

+ Reviews and responds to all types of Medicare audits, including ADR FCSO, RAC, CERT, Targeted Probe & Educate, Livanta QIO, SSR, HWDRG, First Coast, SMRC Noridian, and ZPIC.

+ Performs pre-operative surgical reviews for high audit risk surgeries for all payers based on a specific algorithm at least 7 days pre-operatively.

+ Collaborates with Pre-Access, IP auth teams, Utilization Management, Physician Advisors, Nursing, Physicians, Care Management, Coding, and others to ensure appropriate patient statusing based on data and information compilation.

+ Conducts C-indicator/IP only surgical reviews for Medicare and Managed Medicare payers per regulatory rules and regulations.

+ Reaches out to appropriate stakeholders to ensure patients are in the correct status pre-operative and/or in the immediate post-operative period.

The expertise and experiences you’ll need to succeed:

QUALIFICATION REQUIREMENTS:

Bachelor's (Required), Master's of NursingCertified Case Manager (CCM) - EV Accredited Issuing Body, Certified Professional in Healthcare Risk Management (CPHRM) - EV Accredited Issuing Body, Registered Nurse (RN) - EV Accredited Issuing Body

Pay Range:

$60,151.66 - $111,886.39

_This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances._

**Category:** Patient Financial Services

**Organization:** AdventHealth Orlando Support

**Schedule:** Full time

**Shift:** Day

**Req ID:** 150661825