Contract Modeling Analyst

Nemours is seeking a Contract Modeling Analyst to join our team!

This position is remote with occasional travel. Applicants must reside in one of the following states:Alabama Colorado Delaware the District of Columbia Florida Georgia Illinois Maryland Missouri New Jersey New York North Carolina Ohio Pennsylvania South Carolina Tennessee Texas and Virginia.

Implementation and maintenance of Epics Contract Reimbursement system including but not limited to Contracts Networks Payors and Plans and all other inter-related Epic masterfiles for both professional practices and the hospitals to ensure proper calculation of accounts receivable. Prepares analysis of current physician and hospital contractual state to support the model of the financial impact of reimbursement methods and contractual rates and language which facilitate the final physician and hospital contractual language and rate agreement during the evolvement of the contract negotiations within the managed care organization.

Responsibilities:

1. 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 organizations accounts receivable in accordance with contract terms.

2. 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.

3. 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.

4. Develop and maintain provider networks and fee schedules for facility non-facility CPT codes and modifier reimbursementfor use in the EPIC system in accordance with reimbursement contracts.

5. Develop test implement and maintain Epics 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.

6. 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.

7. Thoroughly document the purpose and details of all system changes.

Qualifications:

• Bachelors 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.

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