Contract Analyst

Nemours is seeking a Contract Analyst (remote) to join our Nemours Children’s Health team in Florida or Delaware.

This position is responsible for: development, implementation and maintenance of the Epic System’s Reimbursement Contracts, Provider Networks, Payor/Plans and Benefits Engine along with other Epic system-related masterfiles.  Assist in the analysis and interpretation of Managed Care Contracts in order to develop information for the Epic System that appropriately coincides with Nemours billing, coding and collection processes.  This is a remote position.

Essential Functions

1.         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. 

2.         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. 

3.         Develop and maintain provider networks and fee schedules for facility, non-facility, CPT codes and modifier reimbursement for use in the EPIC system in accordance with reimbursement contracts.

4.         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. 

5.         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. 

6.         Thoroughly document the purpose and details of all system changes. 

7.         Routinely analyze EPIC system reports against contractual documentation for accuracy of setup. Analyze available information and develop recommendations to resolve discrepancies, implement corrective action as necessary and then appropriately communicate changes to impacted parties.

8.         Run Epic Recalculation/Re-evaluation Utilities as required by historical reimbursement contract, provider network and plan updates; communicate purpose of revisions to management in advance.  Prepare audit reports and communicate results, including financial impact, to management and other impacted parties.

9.         Assist in the development and maintenance of Nemours’ Contract, Network, Payor and Plan Internet based insurance reference guide (e.g., iGuide) in accordance with system setup and in conjunction with the Contracting and Provider Enrollment teams for use by staff, referring physicians and patients. 

Performance Skills

1.         Maintain Epic Certifications as appropriate; demonstrate high proficiency of such. 

2.         Maintain proficiency in the functions of other related departments including, but not limited to, registration, scheduling, charge entry and account management as they directly impact the ability to perform the primary function. 

3.         Sustain a high level of proficiency in interpreting and utilizing the Government managed fee schedules. 

4.         Sustain a high level of proficiency in procedural coding schemes (RBRVS, RVU's, DRG’s etc) to assist in system development and maintenance. 

5.         High level of proficiency using Microsoft Office; most specifically Excel. 

6.         Provide clear and efficient written and verbal communication with customers and peers. 

7.         Analytical, systematic, detailed oriented and customer service oriented. 

8.         Ability to follow work procedures.

Requirements

HS Diploma or equivalent required. Associates degree or equivalent work experience is required.

3 to 5 years of demonstrated strong analytical skills with knowledge of patient accounts or healthcare reimbursement. 

Experience with Epic Benefits Engine and/or Epic Contract Management strongly preferred

Hospital and/or physician billing experience from an analytical perspective strongly preferred