Title: Epic PB Analyst
Type: Contract, on-going go-live at 90+ hospitals for the next 4 years
- Epic PB certification up to date
- Experience with government payers and contracts
- Experience working on at least one entire life cycle implementation in the PB space
- Bachelor's Degree
Responsibilities: 90+ facilities are set to go-live on Epic over the next four years. This individual will be responsible for coordinating all issues that arise in the Professional Billing Application as it directly relates to government payers and contracts.
- Configuration & Maintenance
- All Payer agreements and applicable Fee Schedules obtained through Government/Payer Publications or provided by internal Payer Strategy teams. Resource will need critical thinking and research analysis abilities to pull data needed; won't always be data provided by others.
- Reviews the agreements & language for any reimbursement terms and rate policies, determines the various methodology utilized to calculate reimbursement & develops a build plan for Epic configuration
- Builds terms, fee schedules, components, selection extensions, & pricing extensions
- Payer, DRG, EAPG, APC mapping within the Payer or Benefit Plan tables
- Updates based on ongoing negotiations and regular payer updates, resource will actively monitor government or payer websites
- Monthly, quarterly or yearly updates hard coded within agreements that the ACs proactively support
- Testing & Controls
- Unit Testing for each term to confirm the system configuration
- Test with sample claims and payment provided by the Health Ministry or thru data collection from legacy tools if available
- Utilize the SUP environment with production claims to test configuration logic
- Contract build checklist & Change Management Controls process followed
- Secondary Review for build configuration
- Master Contract Matrix maintained for Implementation Build
- Rate Matrix maintained for live Health Ministries
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