Brown University Health · 1 month ago
Contract Modeling Analyst
Providence, RI
Full-time, Contract
Hybrid
Mid Level
$66K/yr - $110K/yr
3+ years expBrown University Health is an integrated academic health system dedicated to improving health status through high-value services. The Contract Modeling Analyst is responsible for building and maintaining contract models, ensuring reimbursement integrity, and collaborating with stakeholders to resolve contract management issues.
EducationHealth CareMedicalUniversities
Responsibilities
Builds and maintains hospital and physician contract models; ensures integrity of calculated expected reimbursement; researches and troubleshoots payment variance discrepancies; recommends and implements system/modeling improvements
Collaborates with key stakeholders in the timely resolution of contract management updates, issues or system enhancements
Designs and implements facility and professional payor reimbursement models for government and managed care payors in the organization’s contract management system
Interprets contract language and payor payment policies to define and build model terms to ensure accuracy of expected payment calculations
Responsible for maintaining contract management models due to payor rate changes and regulatory updates
Coordinates with IT department to ensure contract model updates are submitted properly and migrated throughout all environments of the billing system in a timely and efficient manner
Validates and approves all contract model updates before implementation in the production system
Audits and monitors contract management reimbursement calculations against actual payments to ensure accuracy and integrity of model build
Identifies and analyzes payor payment variances to determine cause of reimbursement discrepancies
Recommends and implements corrective action to resolve any modeling issues
Works closely with Contracting, Patient Financial Services, and Chargemaster/Revenue Integrity departments to identify and resolve any existing and/or potential problems with billing, charging or contract modeling that may impact the validity of expected payment calculations
Provides ongoing support to maximize system performance
Functions as the Contracting liaison with the contract management system vendor
Escalates and troubleshoots system issues with vendor support staff to ensure system is calculating expected reimbursement properly
Leads the testing of contract management system updates and upgrades to ensure all changes are appropriate and working as expected
Participates in continuing education such as user forums, training classes or seminars regarding changes in regulatory and compliance rules, coding guidelines, reimbursement payment policies or system enhancements
Maintains certifications as required to perform job duties
Performs other duties as assigned
Qualification
Required
College graduate preferred with degree in Business, Finance, Health Administration or related field
Three years of experience in healthcare with an emphasis in one of the following areas: reimbursement, contracting, or patient accounting
Ability to interpret managed care and CMS contract language
Detailed knowledge of payor reimbursement methodologies
Highly organized with strong project management skills, including the ability to meet deadlines, effectively communicate with all levels of the organization, and work as part of a team
Preferred
Knowledge of EPIC Resolute HB/PB application or other contract management software
Company
Brown University Health
Brown University Health provides an integrated academic health system offering hospital services, outpatient care and clinical education.
10001+ employees
Funding
Current Stage
Late StageRecent News
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