Epic Reimbursement Contract Specialist (FT- 1.0 FTE, Day Shift, Remote Possible)

Position Summary: 

The Epic Reimbursement Contract Specialist is responsible for building and maintaining the HB (Hospital Billing) and PB (Professional Billing) expected reimbursement contracts in Epic while acting as a subject matter expert in variance reporting and reimbursement analysis. This position will work incoming flagged underpayments and overpayments, collaboratively appeal confirmed underpayment instances, and continuously build and maintain system contract configuration to ensure accuracy against payer reimbursement terms.  Further, this role will perform extensive reimbursement analysis, pinpointing recurring themes surrounding underpayments and identifying patterns for underpayments based on payer, service line, and other factors.

 Qualifications:

• Bachelor degree in Information Systems, Informatics, Business Administration or related field; equivalent combination of education and experience may be considered.

• Epic certification in Hospital Billing and Professional Billing Expected Reimbursement Contracts Administration or ability to obtain within six (6) months of hire.

• Three (3) years of direct experience working on Epic Contracts Reimbursements Hospital Billing/Professional Billing including but not limited to ability to translate payer contracts into Epic system specifications using contract build tools, understanding of medical terminology, claims billing, and both inpatient and outpatient coding, ability to utilize Epic reporting tools including Alexandria Report, Contract Variance Reports, and SlicerDicer to perform in-depth underpayment analysis and identify underpayment patterns and payer trends

• May consider five (5) years of experience in applicable clinical/business experience preferably in a multi-entity health care system, large hospital, physical office, or managed care organization.

Essential Job Functions:  In addition to the essential functions of the job listed below, employees must have on-time completion of all required education as assigned per DNV requirements, Bozeman Health policy, and other registry requirements.

• Design, build, analyze, test, and provide support for Epic’s Reimbursement Contracts 

• Serve as the subject matter expert for Epic’s HB & PB Reimbursement Contracts modules 

• Provide support to other revenue cycle areas regarding questions on calculations and reimbursement generated by the contract builds 

• Liaise with IT and operations on Epic functionality, workflows, documentation, best practices, and change management 

• Perform regular system audits to determine contract accuracy in HB & PB expected reimbursements  

• Identify and reconcile all payment variances discovered during various audits conducted at Bozeman Health 

• Maintain a schedule of key update dates for expected reimbursement rules, such as Medicare OP quarterly updates, yearly Diagnostic Related Group (DRG) updates, and yearly increases for the Managed Care contracts 

• Communicate with payers and maintain up-to-date HB & PB contract inventory and payer-plan master files 

• Coordinate and actively participate with other associates and leaders on the team to expand and grow their knowledge of contract reimbursement models

Knowledge, Skills and Abilities

• Demonstrates sound judgment, patience, and maintains a professional demeanor at all times

• Exercises tact, discretion, sensitivity, and maintains confidentiality

• Performs essential job functions successfully in a busy and stressful environment

• Learns current and new computer applications and office equipment utilized at Bozeman Health

• Strong interpersonal, verbal, and written communication skills

• Analyzes, organizes, and prioritizes work while meeting multiple deadlines

Schedule Requirements

• This role requires regular and sustained attendance.

• The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts.

• On-call work may be required to respond promptly to organizational, patient, or employee needs.

Physical Requirements

Lifting (Rarely – 30 pounds): Exerting force occasionally and/or usi