Contract Modeling Analyst

SUMMARY:

The Contract Modeling Analyst reports to the Manager Contract Modeling & Revenue Recovery.  Under general supervision, builds and maintains hospital and physician contract models; ensures integrity of calculated expected reimbursement; researches and troubleshoots payment variance discrepancies; recommends and implements system/modeling improvements.  Collaborates with key stakeholders in the timely resolution of contract management updates, issues or system enhancements.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these guide our everyday actions with patients, customers and one another.

Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive, integrated academic health system.  Is responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct.

Designs and implements facility and professional payor reimbursement models for government and managed care payors in the organization’s contract management system.  Interprets contract language and payor payment policies to define and build model terms to ensure accuracy of expected payment calculations.  Responsible for maintaining contract management models due to payor rate changes and regulatory updates.

Coordinates with IT department to ensure contract model updates are submitted properly and migrated throughout all environments of the billing system in a timely and efficient manner.  Validates and approves all contract model updates before implementation in the production system.

Audits and monitors contract management reimbursement calculations against actual payments to ensure accuracy and integrity of model build.  Identifies and analyzes payor payment variances to determine cause of reimbursement discrepancies.  Recommends and implements corrective action to resolve any modeling issues.

Works closely with Contracting, Patient Financial Services, and Chargemaster/Revenue Integrity departments to identify and resolve any existing and/or potential problems with billing, charging or contract modeling that may impact the validity of expected payment calculations.  Provides ongoing support to maximize system performance.

Functions as the Contracting liaison with the contract management system vendor.  Escalates and troubleshoots system issues with vendor support staff to ensure system is calculating expected reimbursement properly.  Leads the testing of contract management system updates and upgrades to ensure all changes are appropriate and working as expected. 

Participates in continuing education such as user forums, training classes or seminars regarding changes in regulatory and compliance rules, coding guidelines, reimbursement payment policies or system enhancements.  Maintains certifications as required to perform job duties.

Performs other duties as assigned.

EDUCATION:

College graduate preferred with degree in Business, Finance, Health Administration or related field.

EXPERIENCE:

Three years of experience in healthcare with an emphasis in one of the following areas:  reimbursement, contracting, or patient accounting.  Ability to interpret managed care and CMS contract language.  Detailed knowledge of payor reimbursement methodologies.  Highly organized with strong project management skills, including the ability to meet deadlines, effectively communicate with all levels of the organization, and work as part of a team.  Knowledge of EPIC Resolute HB/PB application or other contract management software preferred.

Pay Range:

$66,397.24-$109,529.06

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

BHCS 15 LaSalle Square - 15 LaSalle Square Providence, Rhode Island 02903

Work Type:

M-F 8am-4:30pm (Flexible)

Work Shift:

Day

Daily Hours: 

8 hours

Driving Required:

No