合同建模分析师
Contract Modeling Analyst
Nemours 正在寻找一名合同建模分析师加入我们的团队！
该职位为远程办公，偶尔需要出差。申请人必须居住在以下各州之一：阿拉巴马州、科罗拉多州、特拉华州、哥伦比亚特区、佛罗里达州、佐治亚州、伊利诺伊州、马里兰州、密苏里州、新泽西州、纽约州、北卡罗来纳州、俄亥俄州、宾夕法尼亚州、南卡罗来纳州、田纳西州、德克萨斯州和弗吉尼亚州。
负责实施和维护 Epic 的合同报销系统，包括但不限于合同、网络、付款人和计划，以及所有其他与 Epic 主数据相关的部分，以确保专业实践和医院的应收账款正确计算。准备当前医生和医院合同状态的分析，以支持管理医疗组织内合同谈判过程中报销方法和合同费率及条款的财务影响模型，从而促进最终医生和医院合同条款及费率协议的达成。
职责：
- 开发、测试、实施和维护 Epic 报销合同，包括但不限于费率和费用表调整、CPT 的添加以及计划、提供者和组件的更新，以根据合同条款准确估算组织的应收账款。
- 通过使用 Epic 建模工具，对合同管理团队提出的合同提案进行实施和测试，并向领导层提供财务影响的执行摘要分析，就如何优化提案的报销提出建议，适用于不同付款人。确保对管理医疗团队的分析请求（无论是临时报告、特殊分析还是建模请求）及时准确地响应。
- 根据已识别的情况，必要时开发、测试、实施和维护 Epic 定价合同，包括但不限于费率、费用表、CPT 和提供者调整。
- 根据报销合同，开发和维护设施、非设施、CPT 代码和修饰符的提供者网络和费用表，用于 Epic 系统中。
- 开发、测试、实施和维护 Epic 的福利引擎系统，包括但不限于组件、组件组、裁定表和福利包，以准确估算患者的财务责任和标准授权/预认证要求。
- 开发、测试、实施和维护 Epic 的福利引擎系统，包括但不限于组件、组件组、裁定表和福利包，以准确估算患者的财务责任和标准授权/预认证要求。
查看英文原文
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:
- 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 reimbursementfor 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.
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.
Originally posted on Himalayas