Contract Modeling Analyst
US-CO-ENGLEWOOD
commonspirit_careers
Req #: 380981
Type: Day
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Overview: CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. Responsibilities: Job Summary / Job Purpose Responsible for building and testing the contract modeling calculation that applies the contractual adjustment at time of billing and produces the Expected Payment within the AR/Revenue Cycle system (Meditech, PCON, Epic, PIC). This position directly impacts CHI's financial statements as these calculations are relied upon to estimate Net AR (on CHI's balance sheet) and is a focus of the financial audit. Key Responsibilities * Reimbursement Calculation/Contract build/modeling - (Business critical maintenance) - Input and maintenance of Payor contracts to calculate net expected reimbursement and applies the contractual adjustment at the time of billing. For Meditech and/or PCON, Epic, PIC * Ensures accurate and timely maintenance of reimbursement calculation in system dictionaries and tables, based on collaboration with Payor Strategy and RRC management. * Interprets managed care contracts and government reimbursement methodologies in order to correctly create the contract modeling calculation. * Ensure thorough testing of all new and existing entries into the Contract Modeling/Revenue Cycle system to confirm accurate calculations for netting down AR at time of billing. * Assists or works directly with other business partners as it relates to managed care contracts and government reimbursement changes that impact expected payment Qualifications: Job Requirements / Qualifications Education / Accreditation / Licensure (required & preferred): Bachelor's Degree preferred. Experience (required & preferred): Three to five years of related Revenue Cycle application experience in contract modeling and/or experience in Patient Financial Services or Finance preferred. Must have extensive experience and knowledge with healthcare reimbursement methodologies and concepts.
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