Contract Modeling Analyst

Nemours Children's Health$80K — $95K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree or equivalent healthcare specific work experience
  • Epic Professional Billing Reimbursement Contracts Certification
  • Epic Hospital Billing Expected Reimbursement Contracts Certification
  • 5+ years of strong analytical skills
  • Knowledge of healthcare contract analysis and reimbursement

Responsibilities

  • Develop and maintain Epic reimbursement contracts and fee schedules
  • Test contract proposals and analyze financial impact using EPIC modeling
  • Implement Epic pricing contracts and provider adjustments
  • Maintain provider networks and reimbursement codes in EPIC
  • Oversee Epic's Benefits Engine system for patient financial estimation
  • Manage Payor and Plan masterfiles to ensure accuracy in patient registration
  • Document all system changes thoroughly

Benefits

  • Remote work with occasional travel
  • Eligibility in various states
  • Opportunity to work with advanced EPIC systems
  • Engagement in contract negotiations
Full Job Description
Job Description

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 Epic's 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 organization's 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 reimbursement for use in the EPIC system in accordance with reimbursement contracts.
  5. 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.
  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:
  • 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.

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About Nemours Children's Health

Nemours Children's Health Careers

There has never been a better time to explore the diverse job opportunities at Nemours Children's Health, a leading organization in pediatric healthcare. Nemours Children's Health is renowned for its commitment to innovation and excellence in child health services.

Work You’ll Do

Join Nemours Children's Health to assist in transforming pediatric healthcare and improving the lives of children across the nation. Nemours Children's Health stands at the forefront of medical innovation and patient care, making it an ideal environment for professionals looking to make a significant impact. Engage in meaningful work that combines cutting-edge technology, deep industry expertise, and a passion for enhancing children's health outcomes. Nemours Children's Health offers a unique position in the marketplace, enabling team members to lead in pediatric healthcare through advanced technology and innovative healthcare solutions. Collaborate with a dedicated team of healthcare professionals who are committed to driving change and fostering a culture of excellence and compassion.

Nemours Children's Health Employment Opportunities

The team is actively building its workforce to support and advance pediatric healthcare services. Nemours Children's Health offers a variety of positions, from clinical roles to administrative support, each contributing to the overarching goal of children's health and wellness.

Innovative Work and Career Growth

Nemours Children's Health is home to a vast network of healthcare professionals—each dedicated to pediatric care and committed to leadership and professional growth. The organization encourages continuous professional development and leadership training to ensure that team members are equipped to lead and innovate in their fields.

Be Part of a Diverse and Inclusive Team

Nemours Children's Health prioritizes diversity and inclusion, creating a welcoming environment where all team members can thrive. The organization offers diversity training and promotes a culture where different perspectives are valued and celebrated.

Future-Proof Your Career

Nemours Children's Health provides extensive support for career advancement, including professional development programs, certification support, and leadership training. The potential for growth within the organization is substantial, driven by a commitment to internal promotion and professional enrichment.

Explore Job Opportunities and Internships

Nemours Children's Health offers a range of job opportunities and internships, providing a pathway for those at the start of their careers to gain valuable experience in the healthcare industry. Positions are designed to harness the skills and enthusiasm of new entrants to the professional world, integrating them into a team that is passionate about children's health and well-being.

The Nemours Children's Health Network

By joining Nemours Children's Health, team members become part of a respected network known for its commitment to innovation and quality care. The collaborative environment ensures that all members have access to the tools and resources necessary to excel in their roles.

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