Contract Modeling Analyst
The posted compensation range of $32.08 - $46.51 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities
Job Summary / Job Purpose
Responsible for building and testing the contract modeling calculation that applies the contractual adjustment at time of billing and produces the Expected Payment within the AR/Revenue Cycle system (Meditech, PCON, Epic, PIC). This position directly impacts CHI’s financial statements as these calculations are relied upon to estimate Net AR (on CHI’s balance sheet) and is a focus of the financial audit.
Key Responsibilities
- Reimbursement Calculation/Contract build/modeling – (Business critical maintenance) – Input and maintenance of Payor contracts to calculate net expected reimbursement and applies the contractual adjustment at the time of billing. For Meditech and/or PCON, Epic, PIC
- Ensures accurate and timely maintenance of reimbursement calculation in system dictionaries and tables, based on collaboration with Payor Strategy and RRC management.
- Interprets managed care contracts and government reimbursement methodologies in order to correctly create the contract modeling calculation.
- Ensure thorough testing of all new and existing entries into the Contract Modeling/Revenue Cycle system to confirm accurate calculations for netting down AR at time of billing.
- Assists or works directly with other business partners as it relates to managed care contracts and government reimbursement changes that impact expected payment
Qualifications
Job Requirements / Qualifications
Education / Accreditation / Licensure (required & preferred): Bachelor’s Degree preferred.
Experience (required & preferred): Three to five years of related Revenue Cycle application experience in contract modeling and/or experience in Patient Financial Services or Finance preferred.
Must have extensive experience and knowledge with healthcare reimbursement methodologies and concepts.
Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.
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Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible employees may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit https://www.commonspirit.careers/benefits.
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Equal Opportunity
CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here [PDF].
CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.