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 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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