Financial Systems Anlst 2

Baylor Scott & White Health; San Juan (PR); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Health benefits

401(k) matching up to 5%

Tuition Reimbursement

PTO accrual starting Day 1

Job summary

Baylor Scott & White Health is seeking a contract and reimbursement specialist to support managed care and government contracts within Epic Hospital Billing (HB) and Professional Billing (PB). You will monitor contract performance, identify underpayments, and uncover revenue opportunities.

Key duties include configuring contracts in Epic HB/PB, translating terms, and developing test scenarios to ensure accurate reimbursement.

Qualifications

• Bachelor's degree or 4 years of work experience above minimum qualification.
• 5 years of Managed Care, Government Finance, Revenue Cycle, Billing, or related healthcare fields.
• Experience with CMS or Texas Medicaid Programs.
• Experience in Epic HB/PB or other EHR systems.

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 in Epic HB and PB contracts.
• Investigate reimbursement discrepancies and coordinate with Managed Care, Government Finance, Revenue Cycle, Patient Financial Services, IT, and payer reps for resolution.
• Maintain payer and plan mapping to ensure contracts link to payers, plans, products, service areas, location, and billing entities.
• Maintain build specs, testing evidence, approvals, change controls, and SOPs.
• Serve as cross-functional liaison to explain contract terms and Epic reimbursement logic to Revenue Cycle and Patient Financial Services teams.
• Stay current on CMS, Medicare, Medicaid reimbursement rules, fee schedules, and policy updates.

Skills

Contract management

Payer reimbursement

CMS/Medicare/Medicaid knowledge

Cross-functional collaboration

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.