Contract Modeling Specialist l

Thank you for considering a career at Ensemble Health Partners!

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.

Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference

The Opportunity:

The primary role of the Contract Modeling Specialist level I is to support client needs relative to Insurance contract management.  The specialist will be responsible for Interpretation of Insurance contract verbiage, govt payer reimbursement, and support functions such as file balancing, account/report review and peer audits. 

Ideal Candidates will have Hospital or Physician Insurance contract build experience, Managed Care experience, as well as contract management platform experience related to reimbursement and contracted rates. 

Essential Functions:

• Conduct file balancing and daily maintenance of contract management system Maintains 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 utilizing such tools as a Smartsheet for tracking.
• Complete contract build testing to ensure accuracy prior to moving to a production environment.
• Complete contract audits on completed builds as required.
• Provide support to other revenue cycle areas regarding questions on calculations and reimbursement generated by the contract builds.
• Completes necessary training modules and work building sessions to become Coordinates and actively participates with other associates and leaders on the team to expand and grow their knowledge of managed care organizations, contracts and products.
• Participates with the Contract Management knowledge share opportunities to expand their knowledge base and role.

Requirements:

• High School Diploma or GED

2-4 years’ experience in healthcare industry relative to payer reimbursement to include:

• Hospital or Physician Insurance contract build experience
• Managed Care experience
• Interpretation of Insurance contract verbiage
• Contract management platform experience related to reimbursement and contracted rates. 
• Revenue Cycle Management

Certifications:

• Must obtain CRCR certification within 9 months of hire – employer paid

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Join an award-winning company

Three-time winner of “Best in KLAS” 2020-2022

2022 Top Workplaces Healthcare Industry Award

2022 Top Workplaces USA Award

2022 Top Workplaces Culture Excellence Awards

• Innovation

• Work-Life Flexibility

• Leadership

• Purpose + Values

Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:

• Associate Benefits –  We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs. 
• Our Culture – Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.  
• Growth – We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement. 
• Recognition – We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company. 

Ensemble Health Partners is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws.  Ensemble Health Partners also prohibits harassment of applicants or employees based on any of these protected categories.

Ensemble Health Partners provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.

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