Financial Systems Anlst 2

Baylor Scott & White Health; Baton Rouge (LA); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health insurance

401(k) savings plan

Tuition Reimbursement

PTO accrual beginning Day 1

Job summary

Baylor Scott & White Health seeks a contract and reimbursement specialist to support managed care and government contracts within Epic Hospital Billing (HB) and Professional Billing (PB). You will monitor performance, identify underpayments, and pursue revenue opportunities with cross-functional teams.

Responsibilities include configuring payer contracts, translating terms, testing reimbursement calculations, and staying current with CMS/Medicare/Medicaid guidelines to ensure accurate payments

Qualifications

• Bachelor's degree or equivalent experience.
• 5+ years in Managed Care, Government Finance, Revenue Cycle, or related healthcare fields.
• Experience with CMS or Texas Medicaid programs.
• Experience with payer reimbursement and contract analysis.

Responsibilities

• Configure payer reimbursement contracts in HB and PB.
• Translate contract terms, exclusions, stop-loss provisions, fee schedules, and payment methodologies.
• Develop test scenarios to validate reimbursement calculations loaded in HB and PB contracts.
• Research reimbursement discrepancies and collaborate with stakeholders for resolution.
• Maintain payer and plan mapping to connect contracts to payers, plans, products, service areas, locations, and billing entities.
• Maintain build specifications, testing evidence, and change controls.
• Explain contract terms and Epic reimbursement logic to Revenue Cycle and other teams.
• Stay current on CMS, Medicare, and Medicaid reimbursement rules and policy updates.

Skills

CMS/Medicare/Medicaid knowledge

Payer reimbursement

Education

Bachelor's degree or equivalent experience

Tools

Epic HB/PB

Job description

About Us

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

We serve faithfully by doing what's right with a joyful heart.

We never settle by constantly striving for better.

We are in it together by supporting one another and those we serve.

We make an impact by taking initiative and delivering exceptional experience.

Benefits

Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include:

Immediate eligibility for health and welfare benefits

401(k) savings plan with dollar-for-dollar match up to 5%

Tuition Reimbursement

PTO accrual beginning Day 1

Note: Benefits may vary based upon position type and/or level.

Job Summary

Primary responsibilities include supporting the preparation, implementation, testing, and maintenance of managed care and government reimbursement contracts within Epic Hospital Billing (HB) and Professional Biling (PB). Other tasks include the ongoing monitoring of contract performance, and identification of underpayments and revenue opportunities.

Essential Functions of the Role

• Configure payer reimbursement contracts in Epic Hospital Billing (HB) and Professional Billing (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.

Key Success Factors

• Bachelor's or equivalent experience.




• Five years of Managed Care, Government Finance, Revenue Cycle, Billing, or other related fields within a healthcare environment.




• Experience with CMS or Texas Medicaid Programs.




• Experience in Epic HB/PB or any other EHR software.




• Business office operations/processes.




• Application troubleshooting.




• Managed Care contract and payer reimbursement.

Belonging Statement

We believe that all people should feel welcomed, valued and supported.

QUALIFICATIONS

• Education - Bachelor's or 4 years of work experience above the minimum qualification




• Experience - 3 to 5 Years of Experience

As a health care system committed to improving the health of those we serve, we are asking our employees to model the same behaviours that we promote to our patients. As of January 1, 2012, Baylor Scott & White Health no longer hires individuals who use nicotine products. We are an equal opportunity employer committed to ensuring a diverse workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.