Rev Cycle Contract Modeler

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

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 envir