Major Responsibilities:

• Review/interpret federal, state, and managed care reimbursement rules and/or contract terms to model/build and calculate net revenue related to reimbursement of Illnois hospital and professional services. Review/interpret and model/build reimbursement rules and/or contract terms and conditions as outlined in the contracts to accurately calculate net revenue for Illinois hospital and professional services within the contract management and/or decision support systems/software.

  2.Model state-approved standardized contracts, terms and approved alternatives (templates, attachments, fee schedules, amendments, etc.) to ensure contract policy compliance and maximized reimbursement and net revenue. Demonstrate strong ability to understand/interpret and model a variety of contract terms/reimbursement tables within contract management and decision support software and supporting systems. Identify, track, and communicate opportunities to optimize reimbursement and net revenue.

  3.Daily, weekly, and monthly, audit/monitor/report the accuracy of net revenue calculations. Review and monitor contractual allowances and variances in expected reimbursement. Identify origins of underpayments, overpayments, or modeling discrepancies and perform root cause analysis to identify process, system, and/or contract modeling errors.

  4.Utilize reports to validate modeling results to meet reimbursement expectations. Review individual contract terms that do not model accurately. Identify root cause of errors and make recommendations for correction. Apply approved and tested correction to model/build. Recalculate impacted accounts to ensure corrected contractual allowances are sent to patient accounts, keeping contract management/decision support and patient accounting systems in sync.

  5.Collaborate with Revenue Cycle and other AAH departments to resolve contract language interpretation issues that result in a difference between what is modeled/built and what is reimbursed by the payer. Track and present payer trends to Revenue Cycle management and APP Contracting. Produce reports/spreadsheets to illustrate findings providing detailed analysis.

• Liaison/Training - Provide ongoing support and tools for internal and external customers related to AAH Illinois hospital and professional contracts. Assist with training and education of AAH associates on contract language and reimbursement methods. Provide support to management for meetings with payers, APP, Supply Chain, Reimbursement, Finance, etc. to review modeling/reimbursement methodologies or results as needed.

• Serve as a subject matter expert between Reimbursement, Finance, and the Revenue Cycle to ensure accurate and timely net revenue modeling for accurate contractual allowance booking. Prepare necessary documentation/ tools for departmental cross training. Participate in Federal, State or Managed care payer training sessions/seminars.

• Adhere to AAH, Revenue Cycle, and departmental policies and procedures. Accountable and evaluated to organization behaviors of excellence.

Education/Experience Required:

• Bachelor's degree (or equivalent work experience)

• 2 years Progressive experience within a large hospital or integrated healthcare delivery system in revenue cycle/contract management/healthcare systems.

Knowledge, Skills & Abilities Required:

• Experience in Epic and Strata highly desired.
• Ability to work with contracts and translate those into contract modeling systems.
• Strong skills in Microsoft Office suite, including advanced Excel skills.
• Demonstrated ability to build collaborative working relationships.
• Demonstrated self-directed, results oriented and creative approach to problem solving.
• Ability to communicate effectively, including presentations to leadership.
• Knowledge of third-party payer, Medicare/Medicaid guidelines.

Physical Requirements and Working Conditions:

• This position may require occasional travel; therefore, will be exposed to weather and road conditions.
• Must be able to sit the majority of the workday..
• Exposed to a normal office or home office environment.
• This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.