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.
1. Develop, test, implement and maintain Epic reimbursement contracts including, but not limited to, rate and fee schedule adjustments, addition of CPTs and plan, provider, and component updates to provide for accurate estimation of organization’s accounts receivable in accordance with contract terms. 2. Develop, test, implement and maintain Epic pricing contracts as needed to include, but not limited to, rate, fee schedule, CPTs and provider adjustments in accordance with identified situation. 3. Develop and maintain provider networks and fee schedules for facility, non-facility, CPT codes and modifier reimbursement for use in the EPIC system in accordance with reimbursement contracts. 4. Develop, test, implement and maintain Epic’s Benefits Engine system including, but not limited to, components, component groups, adjudication tables and benefit packages in order to accurately estimate patient financial responsibility and standard authorization/precert requirements. 5. Develop, test, implement and maintain Epic Payor and Plan masterfiles in accordance with department policy in order to provide for a comprehensive and accurate selection of plans for patient registration, patient benefit estimation and contractual discount adjustments as appropriate. 6. Thoroughly document the purpose and details of all system changes. 7. Routinely analyze EPIC system reports against contractual documentation for accuracy of setup. Analyze available information and develop recommendations to resolve discrepancies, implement corrective action as necessary and then appropriately communicate changes to impacted parties. 8. Run Epic Recalculation/Re-evaluation Utilities as required by historical reimbursement contract, provider network and plan updates; communicate purpose of revisions to management in advance. Prepare audit reports and communicate results, including financial impact, to management and other impacted parties. 9. Assist in the development and maintenance of Nemours’ Contract, Network, Payor and Plan Internet based insurance reference guide (e.g., iGuide) in accordance with system setup and in conjunction with the Contracting and Provider Enrollment teams for use by staff, referring physicians and patients.
1. Maintain Epic Certifications as appropriate; demonstrate high proficiency of such. 2. 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. 3. Sustain a high level of proficiency in interpreting and utilizing the Government managed fee schedules. 4. Sustain a high level of proficiency in procedural coding schemes (RBRVS, RVU's, DRG’s etc) to assist in system development and maintenance. 5. High level of proficiency using Microsoft Office; most specifically Microsoft Access and Excel. 6. Provide clear and efficient written and verbal communication with customers and peers. 7. Analytical, systematic, detailed oriented and customer service oriented. 8. Ability to follow work procedures.
Education and Training:
Associate's degree (2 years of training beyond high school)
3 to 5 years of demonstrated strong analytical skills with knowledge of patient accounts or healthcare reimbursement.
Must be able to demonstrate high proficiency in the use of Epic, and Microsoft Excel.
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.