Ensemble Health Partners · 7 hours ago

Contract Modeling Specialist II

United States

Full-time, Contract

Remote

Entry, Mid Level

$62K/yr - $120K/yr

2+ years exp

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Responsibilities

Maintain an active Epic certification in Epic Contract Management for RHB390 (acute) and/or RPB390 (physician).

Conduct file balancing and daily maintenance of contract management system based on client/system need.

Collaborates with Ensemble Clients to assist with inquiries related to contract accuracy and/or potential reimbursement issues.

Provide support to Contract Modeling Specialists for trouble shooting (including contract review and/or Epic system navigation).

Maintains a schedule of key update dates for expected reimbursement rules, such as Medicare OP quarterly updates, yearly Diagnostic Related Group (DRG) updates, and yearly increases for the Managed Care contracts utilizing such tools as a Smartsheet for tracking.

Uses modeling tools and reports to identify and confirm validity of payment variances for referral to the underpayments team for appeal and/or follow-up.

Provide support to other revenue cycle areas regarding questions on calculations and reimbursement.

Completes necessary training modules and work building sessions to become fluent in contract loading for the client host system, Epic.

Provide ongoing contract validation to support client financial initiatives, including expected reimbursement based reserve calculations for budgeting purposes.

Coordinates and actively participates with other associates and leaders on the team to expand and grow their knowledge of managed care organizations, contracts, and the Epic system.

Knowledgeable in the interpretation of Epic product upgrade Nova Notes and completion of any needed Contract build related to them.

Efficient in the import/export of Epic databases for use in reporting, troubleshooting, and other related tasks.

Proficient in the use of Epic supplied Toolkits for Medicare OP and IP quarterly and annual updates.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Epic RHB390 CertificationEpic RPB390 CertificationContract ManagementMicrosoft ExcelManaged Care KnowledgeContract InterpretationEpic System NavigationContract Loading

Required

High School Diploma or GED

Epic RHB390 or Epic RPB390 Contract Administration Certification

2 years’ experience relative to payer reimbursement with a minimum of 2 years Epic certification in RHB390 or RPB390 Epic certification.

Knowledge of managed care organizations, contracts, and products or applicable healthcare or payer experience relative to position.

Requires a high level of problem-solving ability, initiative and judgment.

Requires the ability to work in a fast-paced environment balancing multiple priorities and utilizing resources aggressively.

Requires the ability to understand and interpret all aspects of a contract with an emphasis on the implementation and operational components of contract terms.

Must be a self-starter with the ability to identify, understand, research, and solve unique and complicated financial and operational provider issues as it relates to their specific contracts.

Microsoft Excel proficiency is recommended.

Excellent interpersonal skills are necessary to develop strong working relationships with internal and external contacts.