Financial Systems Anlst 2

Baylor Scott & White Health; Phoenix (AZ); Sur place; USD 90 000 - 120 000; Plein temps

Avantages offerts par ce poste

Health and welfare benefits

401(k) match up to 5%

Tuition reimbursement

PTO accrual from day 1

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Cross-functional liaison

Payer reimbursement

CMS knowledge

Communication

Formation

Bachelor's degree or 4 years of related experience

Outils

Epic HB/PB

EHR software

Description du poste

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.