Job Summary and ResponsibilitiesJob Summary / Job Purpose Responsible for building and testing the contract modeling calculation that applies the contractual adjustment at time of billing and produces the Expected Payment within the AR/Revenue Cycle system (Meditech, PCON, Epic, PIC). This position directly impacts CHI's financial statements as these calculations are relied upon to estimate Net AR (on CHI's balance sheet) and is a focus of the financial audit.
Key Responsibilities- Reimbursement Calculation/Contract build/modeling - (Business critical maintenance) - Input and maintenance of Payor contracts to calculate net expected reimbursement and applies the contractual adjustment at the time of billing. For Meditech and/or PCON, Epic, PIC
- Ensures accurate and timely maintenance of reimbursement calculation in system dictionaries and tables, based on collaboration with Payor Strategy and RRC management.
- Interprets managed care contracts and government reimbursement methodologies in order to correctly create the contract modeling calculation.
- Ensure thorough testing of all new and existing entries into the Contract Modeling/Revenue Cycle system to confirm accurate calculations for netting down AR at time of billing.
- Assists or works directly with other business partners as it relates to managed care contracts and government reimbursement changes that impact expected payment
Job RequirementsJob Requirements / Qualifications Education / Accreditation / Licensure (required & preferred): Bachelor's Degree preferred.
Experience (required & preferred): Three to five years of related Revenue Cycle application experience in contract modeling and/or experience in Patient Financial Services or Finance preferred.
Must have extensive experience and knowledge with healthcare reimbursement methodologies and concepts.
Preferred - Hospital Billing Expected Reimbursement Contracts certification
