Rev Cycle Contract Modeler Position Available In Fulton, Georgia

Rev Cycle Contract Modeler Wellstar Health System, Inc. – 3.6

Roswell, GA Job Details Full-time Estimated:

$35.5K – $41.5K a year 1 day ago Qualifications Some college Microsoft Excel Mathematics Mid-level Microsoft Office 3 years High school diploma or GED Bachelor’s degree Organizational skills Contracts Computer skills Epic Business Associate’s degree Communication skills

Full Job Description Facility:

1800

Parkway Center Job Summary:

The Contract Modeler/Builder works under the supervison of the Manager for Contract Build & Modeling to: Assist with building, coordinating and auditing contract profiles for accuracy. Assist with evaluating contractuals are taken at the time of billing through the analysis, review and maintenance of WHS’s Contract Management applications and managed care contracts. Assists with providing various departments with reports, both ad-hoc and routine in nature, as needed to assist in the identification of payment variance opportunities and other payment irregularities. Assists the managed care department with the modeling of contract proposals, including what-if scenarios, to demonstrate potential reimbursement, opportunities and/or shortfalls. Work directly with vendor partners and act as vendor liaison to reduce revenue leakage from WellStar.

Core Responsibilities and Essential Functions:

Builds, models, and evaluates contract profiles for accurate projected reimbursement ensuring accounts have expected reimbursement. Interpret with minimal guidance, build and load complex payer contracts into the WellStar Contract Management production system to enable the system to accurately net down accounts receivable at the time of final bill Maintain Contract Manager payor assignments to ensure of the payors are mapped to the correct Contract Manager contract, as well as new payors added to EPIC are accurately included in the Contract Manager system Monitor $0 reimbursement accounts and provide the resolution, to include manually calculating the expected reimbursement, to ensure these accounts are stated at the correct net value in the general ledger system Monitor the payer contract compliance between the expected payment calculation and the actual payment made to WellStar by payer, by contract, by contract term, by patient type, etc. Report and escalate payer performance issues to appropriate parties, such as managed care or the vice president of accounting, as the needs arise Follow-up as needed with other departments (i.e. Managed Care, Account Follow-up. Billing, etc.) to ensure accurate contract compliance Other duties as assigned to support the department and WHS revenue cycle management efforts. Assists with evaluating contractuals taken at the time of billing through the analysis, review and maintenance of Wellstars Contract Management application (MedAssets Contract Manager/ EPIC Contract Management) and managed care contracts Balance the Contract Manager system to the EPIC system on a nightly basis to ensure the systems remain in-synch and that all contractual adjustments calculated by Contract Manager pass to the EPIC system Independently research and resolve various errors on the Contract Manager error report on a daily basis, such as why Contract Manager was not able to calculate an expected reimbursement for a particular claim Assists with maintaining and modifying Contract Manager contracts for CPI increases, as well as other changes, such as incorrect calculations researched and reported by Reimbursement Specialists Assist with compiling adhoc reimbursement reports to assist in demonstrating the contract compliance and assist in identifying possible reimbursement shortfalls in service lines. Assists with providing back-up to the managed care department efforts related to the modeling and analysis of contract proposals. Interpret with minimal guidance and load complex payer contract proposals into the Contract Manager revenue modeling environment to generate expected reimbursement results for proposals Assist with compiling revenue modeling reports into a user-friendly product utilizing Microsoft Excel that illustrates to management the financial implications of contract proposals vs current contracts Assist with providing the modeling of what-if scenarios to various contract changes during contract negotiations or on an adhoc basis Recommend opportunites and/or challenges to increase reimbursement and/or protect WellStar from reimbursement shortfalls thru the analysis of payor proposals Effectively communicate results of the modeling efforts to RCCOS management team Work in the revenue modeling environment to move signed contracts that have been modeled in the revenue modeling environment to the production environment Provide support to WHS/vendor staff or revenue cycle stakeholders Assist with ensuring projects are completed on time and accurately Provide insight on problem resolution Attend bi-weekly revenue cycle/IS meeting and communicate issues that need attention to RCCOS management team Attend payor JOC and various meetings as required

Required Minimum Education:

Associate’s Degree in business, mathematics or similar degree required Required and Bachelor’s Degree Preferred Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated. Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 3 years of experience in Contract Build and Modeling in combination with completion of High School Diploma from an accredited institution and some college coursework may substitute for a Associate Degree or higher Required and Minimum 3 years of related healthcare contract modeling/build experience. Knowledge of EPIC is preferred.

Preferred Required Minimum Skills:

Strong contracts review, analytical, communication, and interpersonal skills. Demonstrated ability to support multiple contract audits concurrently. Computer skills include knowledge and use of Microsoft Office including EXCEL. Demonstrated knowledge of health care contract modeling/builds. Must possess effective organization, and educational skills. Strong written and verbal communications.