Epic Revenue Systems Analyst – Healthcare Payer Contracts

Baylor Scott & White Health; San Juan (PR); On-site; USD 90,000 - 130,000; Full time

Benefits offered by this job

Health benefits

401(k) match up to 5%

Tuition reimbursement

PTO accrual Day 1

Job summary

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

In this role you will monitor contract performance, identify underpayments and revenue opportunities, and collaborate with cross-functional teams including Managed Care, Government Finance, Revenue Cycle, Patient Financial Services, IT, and payer

Qualifications

• Bachelor's or equivalent experience.
• 3 to 5 years of experience in related healthcare fields.
• Experience with CMS or Texas Medicaid Programs.
• Experience in Epic HB/PB or any other EHR software.
• Understanding of business office operations and processes.
• Experience with contract and payer reimbursement.

Responsibilities

• Configure payer reimbursement contracts in Epic HB/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

Managed Care experience

Revenue Cycle knowledge

Contract understanding

Communication

Education

Bachelor's degree or equivalent experience

Tools

Epic HB/PB

Job description

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

In this role you will monitor contract performance, identify underpayments and revenue opportunities, and collaborate with cross-functional teams including Managed Care, Government Finance, Revenue Cycle, Patient Financial Services, IT, and payer