Sr Provider Contract Implementation Analyst ( Fully Remote)

Summary:

• The Sr. Contract Implementation Analyst serves as primary resource for provider contracting build and implementation and testing of contract build and implementation, including UAT to ensure that systems accurately reflect a contract’s negotiated terms.

• Successful implementation of contracts goes beyond building contracts within the Epic system. Performing such tasks as determining variances and explaining discrepancies, analyzing performance of contracts, reevaluating expected reimbursement when necessary, and gathering information about the volume of claims that were adjudicated by certain contracts are some of the needed tasks. This type of information is essential for gauging day-to-day or month-to-month expected reimbursement calculations and may be useful when renegotiating contracts.

Key Job Responsibilities

• Performs build, design, implementation, optimization, testing, validation, migration, maintenance, and production support of Epic contract models, and rate calculations.

• Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing, astute at spotting data trends.

• Review and price contract related trends to ensure claims payment accuracy.

• Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (CRs) (i.e.RHCs/FQHCs/fee schedule updates).

• Troubleshoot and problem solve contract implementation issues related to basic system configuration, build parameters for application modules, and contract tracking changes.

• Review contracts and assign pay classes and applicable provider information based on contract language. If configuration is needed to accommodate a contract, notify the appropriate parties.

• Review new and current provider and facility contracts and established state guidelines.

• Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plans, claims, and information systems. Strong understanding of revenue cycle workflow is ideal.

• The Contracts Analyst will work closely with the operational stakeholders in order to understand payer contract details. They should have a strong technical capacity and previous experience with reimbursement contracts, if possible. While ultimate responsibility and accountability of contract success falls on the contract’s builder, it may be appropriate to have several analysts building contracts if contract needs of the organization are very complex.

• Configure contract build, including components, fee schedules, extensions, and locale records.

• Coordinate with key operational stakeholders to test and validate reimbursement terms.

Qualifications:

• 3 years of provider contract implementation, contract analysis or claims analysis experience in managed care, health care setting.

• Government programs, (Medicare and Medicaid) reimbursement and regulation experience.

• Understanding of expected reimbursement contracts.

• Experience within Epic, database programing, and contract release notes.

• Epic Contract Maintenance Certified

• Familiarity with PMMC Contract Management Tools

• Strong technical capacity, contracts are one of the most technical components of Hospital Billing and Professional Billing install. Solid technical aptitude as well as strong business sense to understand the impact of contract changes across the organization.

• Testing, validation, and tracking of contract release notes with technical teams and operational stakeholders.

Knowledge of Reimbursement Methodologies and Medicare Medicaid regulations.

• In depth expertise with Epic, SQL, Excel, query tools

Equal Opportunity Employer-Minorities/Females/Veterans/Individuals with Disabilities/Sexual Orientation/Gender Identity.