Note: The job is a remote job and is open to candidates in USA. Nemours Children's Health is seeking a Contract Modeling Analyst to support healthcare reimbursement operations. The role implements and maintains Epic contract, pricing, benefits, payor, plan, network, and fee schedule systems, while analyzing contractual proposals and their financial impact on reimbursement and patient responsibility.
Responsibilities
- Develop, test, implement and maintain Epic reimbursement contracts including, but not limited to, rate and fee schedule adjustments, addition of CPTs and plan, provider, and component updates to provide for accurate estimation of organization’s accounts receivable in accordance with contract terms
- Implement and test contract proposals from contract management teams by using EPIC modeling tool while providing executive summary analysis to leadership of financial impact and provide recommendations on adjustments to optimize reimbursement for proposal for various payors. Ensure accuracy and timely response to analytic requests of the Managed Care team whether it be adhoc reports, involved unique analysis or modeling requests
- Develop, test, implement and maintain Epic pricing contracts as needed to include, but not limited to, rate, fee schedule, CPTs and provider adjustments in accordance with identified situation
- Develop and maintain provider networks and fee schedules for facility, non-facility, CPT codes and modifier reimbursement for use in the EPIC system in accordance with reimbursement contracts
- Develop, test, implement and maintain Epic’s Benefits Engine system including, but not limited to, components, component groups, adjudication tables and benefit packages in order to accurately estimate patient financial responsibility and standard authorization/precert requirements
- Develop, test, implement and maintain Epic Payor and Plan masterfiles in accordance with department policy in order to provide for a comprehensive and accurate selection of plans for patient registration, patient benefit estimation and contractual discount adjustments as appropriate
- Thoroughly document the purpose and details of all system changes
Skills
- Bachelor's degree required; or equivalent healthcare specific work experience may be used in lieu of degree
- Epic Professional Billing Reimbursement Contracts Certification and Epic Hospital Billing Expected Reimbursement Contracts Certification required
- 5+ years of demonstrated strong analytical skills with knowledge of patient accounts or healthcare contract analysis and reimbursement
Benefits
- This position is remote.
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