Contract Modeling Specialist II

The primary role of the Contract Modeling Specialist level II is to support client needs relative to contract management with a minimum of 2 years Epic certification and experience.  The specialist II will be responsible for support functions such as contract loading, contract validation, trouble shooting and training.  The specialist II will actively participate with the Contract Management knowledge share opportunities to expand their knowledge base and role along with assisting in expanding the knowledge of their peers by assisting with training and other knowledge share opportunities.

• Maintain an active Epic certification in Epic Contract Management for RHB390 (acute) and/or RPB390 (physician).
• Conduct file balancing and daily maintenance of contract management system based on client/system need.
• Collaborates with Ensemble Clients to assist with inquiries related to contract accuracy and/or potential reimbursement issues. 
• Provide support to Contract Modeling Specialists for trouble shooting (including contract review and/or Epic system navigation).
• 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.
• Uses modeling tools and reports to identify and confirm validity of payment variances for referral to the underpayments team for appeal and/or follow-up.
• Provide support to other revenue cycle areas regarding questions on calculations and reimbursement.
• Completes necessary training modules and work building sessions to become fluent in contract loading for the client host system, Epic.
• Provide ongoing contract validation to support client financial initiatives, including expected reimbursement based reserve calculations for budgeting purposes.
• Coordinates and actively participates with other associates and leaders on the team to expand and grow their knowledge of managed care organizations, contracts, and the Epic system.
• Knowledgeable in the interpretation of Epic product upgrade Nova Notes and completion of any needed Contract build related to them. 
• Efficient in the import/export of Epic databases for use in reporting, troubleshooting, and other related tasks. 
• Proficient in the use of Epic supplied Toolkits for Medicare OP and IP quarterly and annual updates. 

Education Requirements:

High School Diploma or GED

Licensure/Certification Required:

• Epic RHB390 or Epic RPB390 Contract Administration Certification

  HFMA Certified Revenue Cycle Representative

Minimum Years and Type of Experience:

• 2 years’ experience relative to payer reimbursement with a minimum of 2 years Epic certification in RHB390 or RPB390 Epic certification.

Other Knowledge, Skills and Abilities Required:

Knowledge of managed care organizations, contracts, and products or applicable healthcare or payer experience relative to position.  Requires a high level of problem-solving ability, initiative and judgment. Requires the ability to work in a fast-paced environment balancing multiple priorities and utilizing resources aggressively. Requires the ability to understand and interpret all aspects of a contract with an emphasis on the implementation and operational components of contract terms. Must be a self-starter with the ability to identify, understand, research, and solve unique and complicated financial and operational provider issues as it relates to their specific contracts.

Microsoft Excel proficiency is recommended. EPIC and/or other contract management software. Excellent interpersonal skills are necessary to develop strong working relationships with internal and external contacts.