EPIC Managed Care Contract Analyst, Remote

Job Summary:

The Epic Managed Care Contract Analyst is a healthcare professional specializing in analyzing payer contracts and building contract terms in the Epic system (eChart), ensuring accurate billing, optimal reimbursement, and compliance with payer policies by meticulously reviewing contract terms, identifying potential issues, and coordinating necessary adjustments within eChart configuration to optimize revenue cycle operations. Works independently under general supervision, requiring minimal instruction and guidance. Demonstrates high level of proficiency and expertise on software functionality and integration as well as a high-level proficiency of legal contract language. Responsible for building system components, testing, implementation support and maintenance of contract application. Performs in-depth analysis, trouble shooting, data collection, and root cause analysis. Identifies and/or implements potential solutions for issues related to the system. Analyzes/reviews and tests each product release and communicates needed changes to operations. Must be able to document and follow system change control procedures for the system. Works closely with other analysts, payer representatives and operations to ensure that system integrity is maintained. Researches, analyzes, facilitates and implements business and system workflows to expedite process improvement and coordinate business practices. Identifies best practices and implements opportunities for standardization. Prepares activity and other reports as necessary. Provides guidance and mentoring to other team members. Attains and maintains necessary certifications, as applicable, in a timely manner according to policy. This individual should have excellent customer service and stakeholder management skills along with highly effective written / verbal communication and interpersonal skills.

Epic Managed Care Contract Analyst responsibilities include, but are not limited to the following:

• Thoroughly reviewing and interpreting payer contracts to identify key terms for billing codes, payment methodologies, reimbursement rates, and other contractual obligations.
• Staying updated on payer policy changes to ensure eChart contract modeling aligns with guidelines to avoid billing errors and potential compliance issues.
• Assisting payer relations with contract modeling for payer negotiations.
• Assisting underpayment / denial analyst with contract variances, denial trends, and payment discrepancies to identify areas for improvement and implement necessary adjustments within eChart to maximize reimbursement.
• Utilizing data analytics tools within eChart to monitor contract performance and identify trends.
• Collaborate with payer relations, decision support, billing staff, and revenue cycle management teams to address contract concerns, clarify billing requirements, and ensure accurate implementation within eChart.
• Maintain and manage relationships with payer representatives and attend meetings regularly with representatives for issue resolution and data collection.
• Maintain inventory of payer specific fee schedules, contract terms, and upcoming contract escalators to produce timely and accurate build / mo-ls.
• Work with Erlanger Chief Officers & other executive leadership to ensure accurate Executive Dashboards, monthly general ledger reporting, and accurate service line reporting.

Days and hours worked may be variable.

Education:

Required:

1. High School Diploma and 9 years' experience in one or more of the following: Healthcare, Epic IT, and/or Financial Operations.

OR

1. Associate's degree and 7 years' experience in one or more of the following: Healthcare, Epic IT, and/or Financial Operations.

OR

1. Bachelor's degree and 5 years' experience in one or more of the following: Healthcare, Epic IT, and/or Financial Operations.

Preferred:

N/A

Experience:

Required:

Five years' experience in Epic contract maintenance & modeling with an in-depth knowledge of Epic contract maintenance and modeling modules. Analysts must be able to analyze complex data, identify trends, and draw actionable insights to optimize contract performance. Must have a strong understanding of healthcare contracts, including payer terms, billing codes (CPT, HCPCS, MSDRG, APC, ICD-10, etc.), & reimbursement methodologies.

Preferred:

Seven years' experience in Epic contract maintenance & modeling modules.

Position Requirement(s): License/Certification/Registration

Required:

• Resolute Hospital Billing Expected Reimbursement Contracts Administration (RHB390)
• Resolute Professional Billing Reimbursement Contracts (RPB390)

Preferred:

N/A

'257256