As one of the nation’s leading pediatric health care systems, Nemours is committed to providing all children with their best chance to grow up healthy. We offer integrated, family-centered care to more than 300,000 children each year in our pediatric hospitals, specialty clinics and primary care practices in Delaware, Florida, Maryland, New Jersey and Pennsylvania. Nemours strives to ensure a healthier tomorrow for all children – even those who may never enter our doors – through our world-changing research, education and advocacy efforts. At Nemours, our Associates help us deliver on the promise we make to every family we have the privilege of serving: to treat their child as if they were our own.
This position is responsible for: Development, implementation and maintenance of the Epic System’s Reimbursement Contracts, Provider Networks, Payor/Plans and Benefits Engine along with other Epic system-related masterfiles. Assist in the analysis and interpretation of Managed Care Contracts in order to develop information for the Epic System that appropriately coincides with Nemours billing, coding and collection processes.
The professional we are seeking will be highly motived, excellent communicator with good interpersonal skills. Experience/knowledge of contract language and payment methodologies, strong analytical skills and attention to details are necessary to be successful in this position. Candidate should be comfortable working effectively in both an individual and team setting; both remotely and face to face. The position provides support to the Managed Care Contracting team with the review and evaluation of managed care contract rate proposals using a variety of tools. This position is responsible for maintaining the financial system to calculate expected reimbursement based off existing contracts which requires the ability to understand payment methodology and utilize formulas with system syntax to correctly program reimbursement rates for contracted payors. Given the time-sensitive nature of contractual matters, a contract analyst must be well-organized and skilled at time management. Prior experience with revenue cycle, patient accounting, third party contracting and/or contract modeling systems is a plus. Proficiency in Microsoft Excel and Word is required. The ability to quickly learn the Epic Contract Management System is a must.
Interprets managed care contract terms and payment methodologies for the creation and ongoing maintenance of the Epic financial system, programming within Epic’s Contract Management tool, in order to accurately calculate expected payment at the time of billing.
Supports contract negotiations through review of contract language, development of new reimbursement models, modeling of proposed contract terms and rates and making recommendations as appropriate to department management. Interacts with internal and external parties regarding communication/questions about rates and terms, rate structure and development and reconciliation of contract provisions and disputes.
Responsible for the ongoing maintenance of physician fee schedules and/or hospital rate schedules and evaluates updates for compliance with contract terms.
Routinely performs testing on payor claims to ensure accuracy of system build and compliance to contract terms.
Investigates systematic payment issues identified by department analyses or communicated by leadership.
Makes recommendations that address such issues in current and future contracts.
Analytical, systematic, detailed and customer service oriented.
Provide clear and efficient written and verbal communication with customers and peers.
Maintain Epic Certifications as appropriate; demonstrate high proficiency of such. Maintain proficiency in the functions of other related departments including, but not limited to, registration, scheduling, charge entry and account management as they directly impact the ability to perform the primary function.
Sustain a high level of proficiency in interpreting and utilizing the Government managed fee schedules.
High level of proficiency using Microsoft Office; most specifically Microsoft Access and Excel. Ability to follow work procedures.
Education and Training:
Associate's degree (2 years of training beyond high school)
2 to 5 years of demonstrated strong analytical skills with knowledge of patient accounts or healthcare reimbursement.
Our dedication to professionals who are dedicated to children frequently earns Nemours a spot on the list of top workplaces in the communities we serve. Our Associates enjoy comprehensive benefits, including our unique “Bridge to a Healthy Future” pediatric health plan, an integrated wellness program, opportunities for professional growth, and much more. As an equal opportunity employer, Nemours focuses on the best-qualified applicants for our openings.
Nemours is committed to improving the health of children. As a non-profit children’s health organization, we consider the health of every child to be a sacred trust. Through family-centered care in our children’s hospitals and clinics in Delaware, New Jersey, Pennsylvania and Florida, as well as world-changing research, education and advocacy, Nemours fulfills the promise of a healthier tomorrow for all children — even those who may never enter our doors. Nemours began more than 70 years ago with the vision of Alfred I. duPont to improve the lives of children and to do whatever it takes to prevent and treat even the most disabling childhood conditions. Today, through our children’s hospitals and health system, we directly care for 250,000 children annually in Delaware Valley and Florida, including families who travel from across the country and world to see our specialists — treating every child as we would our own. We also reach beyond the walls of our hospitals and clinics to be a voice for children on a national and international level, and to lead the way in prevention, intervention, education, and research. Nemours is growing to better serve the children and families in our ca...re. We have 1.1 million square feet of space currently devoted to providing children’s healthcare or under construction, all designed with significant input and advice from our patients and families.