Revenue Cycle Contract Modeling Analyst Lead

Where You’ll Work

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

Job Summary and Responsibilities

Job Summary / PurposeResponsible for leading the efforts in building and testing the contract modeling calculation that applies the contractual adjustment at the time of billing and produces the Expected Payment within the AR/Revenue Cycle system (Meditech, PCON, Epic, PIC). This position provides technical guidance on complex modeling scenarios, manages related projects/tasks, and ensures the integrity of calculations, which are relied upon to estimate Net AR, a focus of the financial audit, and to identify and pursue underpayments.

Essential FunctionsEssential Function

• Contract Build and Modeling Leadership: Lead the input, building, testing, and maintenance of Payor contracts to accurately calculate net expected reimbursement and apply contractual adjustments at the time of billing for Epic, Meditech, PCON, and PIC.
• Interpretation and Expertise: Serve as the subject matter expert in interpreting complex managed care contracts and government reimbursement methodologies to correctly create and validate contract modeling calculations
• Quality Assurance & Oversight: Oversee and ensure the thorough and timely testing of all new and existing entries into the Contract Modeling/Revenue Cycle system to confirm accurate netting down of AR at the time of billing. This includes leading implementations and other expected reimbursement projects and processes
• Strategic Collaboration: Proactively collaborate with Payor Strategy, RRC management, and other business partners regarding managed care contracts and government reimbursement changes that impact expected payment and system dictionaries/tables.
• Mentorship and Guidance: Provide technical guidance and support to other team members on reimbursement calculation issues and complex contract modeling tasks

Job Requirements

Education and Experience

Bachelor's degree

5-7 years of related experience in contract modeling and experience in Managed Care, Patient Financial Services or Finance (required).

Must have extensive experience and knowledge with healthcare reimbursement methodologies and concepts.

Experienced in managing technical projects and implementations.

Licensure and Certifications

EPIC Certification (EPIC), Preferred