Contract Modeling Analyst

This is a fully remote position, open to applicants in Alabama, +14 more states.

📋 Description

• Implement and manage Epic’s Contract Reimbursement system, encompassing Contracts, Networks, Payors, Plans, and associated Epic masterfiles.

• Conduct analyses of contractual terms, reimbursement methods, rates, and language for physicians and hospitals to aid in contract negotiations.

• Design, test, implement, and oversee Epic reimbursement contracts, including rates, fee schedules, CPTs, plans, providers, and their components.

• Execute and evaluate contract proposals utilizing the Epic modeling tool.

• Provide executive-summary analyses of financial impacts along with recommendations to enhance reimbursement.

• Address analytic requests from the Managed Care team, including ad hoc reports, specialized analyses, and modeling inquiries.

• Develop and sustain provider networks and facility/non-facility fee schedules, CPT codes, and modifier reimbursements.

• Design, test, implement, and maintain Epic’s Benefits Engine, which includes components, component groups, adjudication tables, and benefit packages.

• Create, test, implement, and manage Epic Payor and Plan masterfiles.

• Thoroughly document the objectives and specifics of all system modifications.

⛳️ Requirements

• A Bachelor’s degree is required; equivalent healthcare-specific work experience may substitute for the degree.

• Epic Professional Billing Reimbursement Contracts Certification is mandatory.

• Epic Hospital Billing Expected Reimbursement Contracts Certification is mandatory.

• A minimum of 5 years demonstrating strong analytical skills with a background in patient accounts or healthcare contract analysis and reimbursement is required.

• 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 setup with occasional travel.

• Opportunity to be part of Nemours Children's Health, a nonprofit pediatric health system.

• Engage in support for clinical care, research, education, advocacy, and prevention.