Epic Revenue Cycle Analyst: Managed Care Reimbursement

Baylor Scott & White Health; Atlanta (GA); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health and welfare benefits

401(k) matching up to 5%

Tuition reimbursement

PTO from day 1

Job summary

Baylor Scott & White Health is seeking a contracts specialist to support the preparation, implementation, testing, and maintenance of managed care and government reimbursement contracts within Epic HB and PB.

The role involves monitoring contract performance, identifying underpayments and revenue opportunities, and collaborating with Finance, IT, Revenue Cycle, and payer teams to resolve issues. A Bachelor's degree and 3–5 years in related fields are expected; CMS/Medicaid experience is a plus.

Qualifications

• Education - Bachelor's degree or 4 years of work experience above the minimum qualification
• Experience - 3 to 5 years in related healthcare fields

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 loaded in Epic HB and PB
• 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 connect to payers, plans, products, service areas, location, and billing entities
• Maintain build specifications, testing evidence, approvals, change controls, and standard operating procedures
• Serve as cross-functional liaison to explain contract terms and Epic reimbursement logic to Revenue Cycle and related teams
• Maintain working knowledge of CMS, Medicare, and Medicaid reimbursement rules and methodologies, fee schedules, regulatory requirements, and policy updates

Skills

Managed Care

Government Finance

Revenue Cycle

Billing

CMS/Medicaid knowledge

Epic HB/PB

EHR systems

Contract management

Education

Bachelor's degree

Tools

Epic HB/PB

EHR software

Job description

Baylor Scott & White Health is seeking a contracts specialist to support the preparation, implementation, testing, and maintenance of managed care and government reimbursement contracts within Epic HB and PB.

The role involves monitoring contract performance, identifying underpayments and revenue opportunities, and collaborating with Finance, IT, Revenue Cycle, and payer teams to resolve issues. A Bachelor's degree and 3–5 years in related fields are expected; CMS/Medicaid experience is a plus.