Contract Modeling Analyst

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🔥 0 minutes ago

🏈 Alabama, Colorado, +13 more states – Remote

🏈 Alabama – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 25%

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Center for Health Care Strategies

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 1998

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Center for Health Care Strategies is a U. S. -based organization dedicated to improving the healthcare system to achieve better and more equitable outcomes, particularly for those served by Medicaid. The center focuses on issues like complex health and social needs, mental health, substance use, and aging and disability. It emphasizes cross-sector partnerships, community engagement, and health equity to transform the delivery system and promote value-based payments. The organization also supports leadership and capacity building efforts to drive system reform, including integrating Medicare and Medicaid services and advocating for trauma-informed care and primary care innovation.

📋 Description

• Implement and maintain Epic’s Contract Reimbursement system, including Contracts, Networks, Payors, Plans, and related Epic masterfiles • Prepare analyses of physician and hospital contractual terms, reimbursement methods, rates, and language to support contract negotiations • Develop, test, implement, and maintain Epic reimbursement contracts, including rates, fee schedules, CPTs, plans, providers, and components • Implement and test contract proposals using the Epic modeling tool • Provide executive-summary analyses of financial impacts and recommendations to optimize reimbursement • Respond to Managed Care team analytic requests, including ad hoc reports, unique analyses, and modeling requests • Develop and maintain provider networks and facility/non-facility fee schedules, CPT codes, and modifier reimbursement • Develop, test, implement, and maintain Epic’s Benefits Engine, including components, component groups, adjudication tables, and benefit packages • Develop, test, implement, and maintain Epic Payor and Plan masterfiles • Thoroughly document the purpose and details of all system changes

🎯 Requirements

• Bachelor’s degree required; equivalent healthcare-specific work experience may be used in lieu of degree • Epic Professional Billing Reimbursement Contracts Certification required • 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 • Applicants must reside in Alabama, Colorado, Delaware, the District of Columbia, Florida, Georgia, Illinois, Maryland, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, or Virginia

🏖️ Benefits

• Remote work arrangement with occasional travel • Opportunity to join Nemours Children's Health, a nonprofit pediatric health system • Work supporting clinical care, research, education, advocacy, and prevention