Payor Reimbursement Analyst

Wage Range: $33.06 - $52.90 per hour

1. Understands and interprets payer contract terms, reimbursement schedules, payment policies, patient accounting billing information and other sources of data to complete analyses and financial projections.
2. Codes payer contract payment terms into Epic to accurately compute expected payments for all claim-types and services billed (this applies to all divisions of EH including both hospitals, medical group, home care/hospice, ambulatory surgery center, ancillary services, etc.)
3. Tests and verifies that all contract terms are calculating appropriately for accurate reporting of expected payment and associated variances.
4. Works with Revenue Cycle team to address any issues related to Epic build and maintenance of expected payments.  This includes application of any billing code discrepancies to contracted terms, appropriate payer, and benefit plan set-up etc.
5. Completes regular reporting from Epic to augment and/or validate data from other reporting systems, i.e. Alliance Decision Support.
6. Assists Contracts Management department in the creation of appropriate dashboards and tracking systems within Epic.
7. Develops and completes statistical and financial analysis reports on payer volumes, payments, contractual adjustments, administrative fees, etc. as needed.
8. Acts as back-up for department needs in regards to building complex scenario models to evaluate the impact of proposed contract rates in support of contract negotiations.
9. Provides ad hoc reporting, as assigned.
10. Participates in applicable Epic forums related to managed care and brings information and improvement opportunities to the attention of department and pertinent EvergreenHealth leadership.
11. Performs other duties as assigned.

• Bachelor’s degree in finance, business, or health administration
• Strong quantitative and analytic skills and ability to drill-down to most relevant findings.
• Proven experience in financial/business analysis

• EPIC certification in Resolute Hospital Billing Expected Reimbursement Contracts Administration or Resolute Professional Billing Reimbursement Contracts
• Minimum 2 years of build analyst experience in Epic and/or equivalent healthcare software. 
• 2 years of experience with health care, financial analysis and/or managed care contracts
• Experience with health insurance operations and payment methodologies
• Experience with patient accounting and claims billing and associated codes
• Experience with Alliance Decision Support (ADS) system and Crystal reports
• Experience with complex business modeling
• Statistical and trend reporting skills

• Medical, vision and dental insurance
• On-demand virtual health care
• Health Savings Account
• Flexible Spending Account
• Life and disability insurance
• Retirement plans 457(b) and 401(a) with employer contribution)
• Tuition assistance for undergraduate and graduate degrees
• Federal Public Service Loan Forgiveness program
• Paid Time Off/Vacation
• Extended Illness Bank/Sick Leave
• Paid holidays
• Voluntary hospital indemnity insurance
• Voluntary identity theft protection
• Voluntary legal insurance
• Pay in lieu of benefits premium program
• Free parking
• Commuter benefits
• Cafeteria & Gift Shop Discount