COMPANY OVERVIEW

For more than 20 years, Revint Solutions has been helping healthcare providers recover revenue and bolster their bottom lines.  Revint Solutions’ recovery methodology and technology platforms work to optimize the revenue cycle.  With the use of intelligent proprietary analytics, our recovery teams are truly the best and most experienced at finding and recovering lost or unidentified revenue.  We take a holistic approach to revenue recovery and look at not only contract compliance, but charge and revenue integrity, as well as regulatory compliance such as Transfer DRG and DRG validation.  Today, we serve over 1,600 hospitals and health systems nationwide and are proud of numerous awards and recognitions, including being consistently named one of the Best Places to Work both locally and nationally.

DESCRIPTION

The Contract Modeling Lead at Revint Solutions is responsible for the design, implementation, and maintenance of calculation models which, utilizing Revint Solutions’ proprietary software, apply the expected reimbursement for all hospital accounts pertaining to a particular payer (e.g., insurance plan, government agency, workers’ compensation). 

The Contract Modeling Lead will work closely with Management to strategically plan audit prioritization and resource allocation.  This position will have leadership responsibilities for categories of payers (e.g., Large Commercial Payers, Medicare/Medicare HMO, Medicaid/Medicaid HMO) and will contribute to the oversight, build, and maintenance of calculation models within their area of expertise.  The Contract Modeling Lead will serve as a Subject Matter Expert regarding managed care contracts, complex payment methodologies, payer manuals laying out additional rules/processes, identification of non-variance underpayment risk (e.g., underpayments resulting from coding updates not outlined in the contract), applicable state legislation, etc. The Contract Modeling Lead will work closely with Management to lead the Contract Modelers and will train, QA, and oversee the calculation models built by junior staff.

The ideal candidate will also be responsible for building more complex calculation models and for trending and analysis of the volume for underpayment risk, including issues spanning multiple accounts. 

RESPONSIBILITIES

• Utilize appropriate methods and flexible interpersonal style to develop and train Contract Modelers. Monitor the work assigned to Modelers and collaborate with Management to outline strategy, priorities, and focus on a weekly and quarterly basis. Support in the annual and mid-year evaluation process for Contract Modelers
• Perform QA of calculation models and trending for accuracy and best practice implementation through the model approval process before models are moved into production. Perform QA of variance and non-variance underpayment related risk areas
• Independently build the logic to apply an expected contractual reimbursement to all claims falling under assigned contracts, taking time to perform self QA and assessment of pricing accuracy
• Perform analysis and trending of the accounts to find areas of revenue opportunity, both due to variance (ex. paid less than expected) as well as non-variance underpayments (ex. missing codes/charges, contract interpretation, new coding updates, etc.). Discern how the insurance company paid a claim and what should have been paid, and will follow department protocol for naming conventions, categorization, and grouping of accounts and will provide explanations for their calculations as well as the assessment of underpayment risk
• Utilize Revint Solutions’ analytic tools to ensure that underpayment risk is thoroughly vetted across different clients and payers, thereby increasing both profitability and efficiency. Further, these tools shall be used to review historic risk areas for particular payers and/or clients and determine if the same underpayment risk area exists in current datasets. Support management in the improvement and maintenance of these tools
• Ongoing maintenance and updating of contract logic as new rates, agreements, and/or fee schedules come into effect for those payers. Stay abreast of industry, coding, and/or payer policy updates and be able to incorporate those changes into their assessment for underpayment risk.  Review outcomes, so that additional improvements and/or corrections may be made to the model

REQUIRED QUALIFICATIONS

• Bachelor’s degree required
• 3 – 4 years of experience in healthcare finance or data analytics role
• 3 – 4 years of experience identifying underpayments with accuracy expectations met
• Working knowledge of managed care contracts and of inpatient and outpatient payment methodologies and payer practices including, but not limited to, Medicare IPPS, first/second dollar stop loss, cost outliers, transfer reductions, Outpatient Fee Schedules (e.g. surgery, drug, therapy, etc.), multiple procedure reductions, tier or APC-based pricing, etc.

DESIRED QUALIFICATIONS

• Strong computer skills with emphasis on Microsoft Excel and Word
• Strong mathematical knowledge with emphasis on complex equations
• Exceptional data analytical and trending skills, including technical skills for querying and categorizing like accounts for efficiency and QA
• Proficient understanding of more complex calculation models (e.g., APC reimbursement, hierarchical global claims rules), data mining (e.g., UB04, Itemized Bill, Clinical Coding, 835/837), and trending/analysis (e.g., coding/billing errors, coding guideline updates, contract interpretation) from both a conceptual and technical standpoint
• Acute attention to detail and ability to perform self-QA to recognize and correct errors with ease
• Ability to deliver feedback, coach, mentor, and QA more junior staff and support them in their development
• Excellent time management and organizational skills, and ability to spend appropriate amount of time on pre-audit planning, volume assessment, contract examination, and trending for payer practices
• Ability to recognize areas of contract interpretation issues and risk areas due to missing qualifiers/volume when reviewing contracts
• Ability to work with people and must maintain confidentiality and exhibit professionalism in personality, appearance, leadership and integrity
• Ability to make sound decisions and recommend appropriate strategies to the leadership team

CULTURE FIT

The culture at Revint Solutions embraces those that demonstrate a deep passion for solving the problems of healthcare with enthusiasm for building positive working relationships and winning as a team.  Take the work seriously, but don’t take yourself too seriously.  Creating a strong workplace culture has been one of our staples, which we believe encourages and inspires employees to do their best.  Join a fulfilling team of like-minded individuals who can get their work done, but still have fun!

BENEFITS

Revint solution provides an extremely competitive benefit package that includes a 401(k) match, medical/dental/vision insurance and more.

Revint Solutions is an Equal Opportunity Employer

Required Skills Required Experience

Education:  Bachelor’s degree