Sys Director Revenue Cycle Contract Modeling

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 / Purpose Responsible for the management of the team that builds and ensure accuracy of the contract modeling calculations that applies the contractual adjustment at time of billing and produces the Expected Payment within the AR/Revenue Cycle system (Epic, PIC, Meditech, PCON) across CommonSpirit. This position directly impacts CommonSpirit's financial statements as these calculations are relied upon to estimate Net AR and is a focus of the financial audit.  These calculations are relied upon to identify and pursue insurance underpayments, which directly affect CommonSpirit's cash and net revenue.

 Essential FunctionsEssential Function

• Oversees the 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 Epic, PIC, Meditech, and Star PCON
• Directs the Contract Modeling team to ensure accurate and timely maintenance of reimbursement calculation in system dictionaries and tables, based on collaboration with Payor Strategy,
• Reimbursement and RRC management.
• Interprets managed care contracts and government reimbursement methodologies in order to manage the creation of the contract modeling calculations.
• Responsible for ensuring thorough testing of all new and existing builds in the Contract Modeling/Revenue Cycle system to confirm accurate calculations for netting down AR at time of billing.
• Works directly with other business partners as it relates to managed care contracts and government reimbursement changes that impact expected payment
• Problem-Solving:  analyzes interrelated elements of problems and works systematically to solve them, uses sound judgment to develop efficient and feasible solutions to challenging issues.
• Initiative: Makes complicated decisions and directs staff to take prompt action to accomplish objectives, goes beyond what is required, seeks to resolve problems without being asked.
• Plans: Organizes tasks and objectives in order of importance and coordinates activities to achieve goals.
• Decision-Making: ability to arrive at fair and reasonable decisions after careful consideration of relevant facts and circumstances

Job Requirements

Education and ExperienceBachelor's degree

10+ years 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.

Requires 5+ years of management experience with a strong background of mentoring and staff development.

Experienced in managing technical projects and implementations.