Epic HB/PB Reimbursement Analyst II

Baylor Scott & White Health; Madison (WI); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

401(k) savings plan with dollar-for-d$

Tuition Reimbursement

PTO accrual beginning Day 1

Job summary

Baylor Scott & White Health in Madison, WI seeks a contract analyst to support the preparation, implementation, testing, and maintenance of managed care contracts within Epic Hospital Billing (HB) and Professional Billing (PB).

You will monitor contract performance, identify underpayments and revenue opportunities, and collaborate with Revenue Cycle, IT, and payer representatives for timely resolutions. This role requires CMS/Medicaid familiarity and strong analytical skills.

Qualifications

• Bachelor's or equivalent experience required.
• 5+ years in Managed Care, Government Finance, Revenue Cycle, or related healthcare fields.
• Experience with CMS or Texas Medicaid programs.
• Experience with Epic HB/PB or other EHR software.
• Strong analytical and problem-solving abilities.

Responsibilities

• Configure payer reimbursement contracts in 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 are loaded in Epic HB and PB contracts.
• Research reimbursement discrepancies and collaborate with Managed Care, Government Finance, Revenue Cycle, Patient Financial Services, IT, and payer representatives for resolution.
• Maintain payer and plan mapping to ensure contracts are connected to the correct payers, plans, products, service areas, location, and billing entities.
• Maintain build specifications, testing evidence, assumptions, approvals, change controls, and standard operating procedures.
• Serve as a cross-functional liaison to explain contract terms and Epic reimbursement logic to Revenue Cycle, Patient Financial Services, and other teams.
• Maintain working knowledge of CMS, Medicare, and Medicaid reimbursement rules and methodologies, fee schedules, regulatory requirements, and policy updates.

Skills

CMS knowledge

Billing experience

Healthcare industry knowledge

Education

Bachelor's degree or equivalent experience

Tools

Epic HB/PB

EHR software

Job description

Baylor Scott & White Health in Madison, WI seeks a contract analyst to support the preparation, implementation, testing, and maintenance of managed care contracts within Epic Hospital Billing (HB) and Professional Billing (PB).

You will monitor contract performance, identify underpayments and revenue opportunities, and collaborate with Revenue Cycle, IT, and payer representatives for timely resolutions. This role requires CMS/Medicaid familiarity and strong analytical skills.