Epic Billing & Reimbursement Analyst

Baylor Scott & White Health; Phoenix (AZ); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health and welfare benefits

401(k) match up to 5%

Tuition reimbursement

PTO accrual from day 1

Job summary

Baylor Scott & White Health is seeking a healthcare reimbursement specialist to support preparation, testing, and maintenance of managed care contracts within Epic Hospital Billing (HB) and Professional Billing (PB). You will monitor contract performance, identify underpayments, and pursue revenue opportunities.

The role requires expertise in CMS/Medicaid rules, payer contract translation, and collaboration with multiple departments to resolve discrepancies and optimize revenue cycle processes.

Qualifications

• Bachelor's or equivalent experience.
• Five years of Managed Care, Government Finance, Revenue Cycle, Billing, or related healthcare field.
• Experience with CMS or Texas Medicaid Programs.
• Experience in Epic HB/PB or other EHR software.
• Business office operations/processes.
• Application troubleshooting.
• Managed Care contract and payer reimbursement.

Responsibilities

• Configure payer reimbursement contracts in Epic HB and PB.
• Translate managed care contracts, reimbursement terms, exclusions, carve-outs, stop-loss provisions, fee schedules, and payment methodologies.
• Develop test scenarios to ensure accurate reimbursement calculations in Epic HB and PB.
• Research reimbursement discrepancies and collaborate with relevant teams for resolution.
• Maintain payer and plan mapping to connect contracts to payers, plans, products, service areas, location, and billing entities.
• Maintain build specifications, testing evidence, assumptions, approvals, change controls, and SOPs.
• Serve as a cross-functional liaison to explain contract terms and Epic reimbursement logic to Revenue Cycle and related teams.
• Maintain knowledge of CMS, Medicare, Medicaid reimbursement rules and methodologies, fee schedules, regulatory requirements, and policy updates.

Skills

Cross-functional liaison

Payer reimbursement

CMS knowledge

Communication

Education

Bachelor's degree or 4 years of related experience

Tools

Epic HB/PB

EHR software

Job description

Baylor Scott & White Health is seeking a healthcare reimbursement specialist to support preparation, testing, and maintenance of managed care contracts within Epic Hospital Billing (HB) and Professional Billing (PB). You will monitor contract performance, identify underpayments, and pursue revenue opportunities.

The role requires expertise in CMS/Medicaid rules, payer contract translation, and collaboration with multiple departments to resolve discrepancies and optimize revenue cycle processes.