Contract Modeling Analyst

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 / Job Purpose 

Responsible for building and testing the contract modeling calculation that applies the contractual adjustment at time of billing and produces the Expected Payment within the AR/Revenue Cycle system (Meditech, PCON, Epic, PIC). This position directly impacts CHI’s financial statements as these calculations are relied upon to estimate Net AR (on CHI’s balance sheet) and is a focus of the financial audit.

Key Responsibilities

• 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 Meditech and/or PCON, Epic, PIC
• Ensures accurate and timely maintenance of reimbursement calculation in system dictionaries and tables, based on collaboration with Payor Strategy and RRC management.
• Interprets managed care contracts and government reimbursement methodologies in order to correctly create the contract modeling calculation.
• Ensure thorough testing of all new and existing entries into the Contract Modeling/Revenue Cycle system to confirm accurate calculations for netting down AR at time of billing.
• Assists or works directly with other business partners as it relates to managed care contracts and government reimbursement changes that impact expected payment

Job Requirements / Qualifications 

Education / Accreditation / Licensure (required & preferred): Bachelor’s Degree preferred. 
Experience (required & preferred):  Three to five years of related Revenue Cycle application experience in contract modeling and/or experience in Patient Financial Services or Finance preferred. 
Must have extensive experience and knowledge with healthcare reimbursement methodologies and concepts. 

Preferred - Hospital Billing Expected Reimbursement Contracts certification