Revenue Cycle Analyst – HB Contracting & Reimbursement

Computer Task Group, Inc•UNAVAILABLE, UNAVAILABLE

3h•Remote

About The Position

CTG is seeking an experienced Revenue Cycle Analyst – HB Contracting & Reimbursement. The Revenue Cycle Analyst specializes in Epic Resolute Hospital Billing (HB) Expected Reimbursement Contracts, Claims, and Remittance configurations. This role serves as the structural bridge between managed care payor negotiations and technical revenue execution. The analyst is responsible for translating complex payor contract matrices into system logic, eliminating financial leakage through automated variance detection, and maintaining end-to-end billing integrity from initial claim generation to final remittance posting.

Requirements

Epic Resolute HB Expected Reimbursement Contracts (Core Expertise)
Epic Resolute Hospital Billing (HB) Administration (Foundational Setup)
Epic Resolute PB Reimbursement Contracts (Cross-functional Application)
Expert capability in constructing contract hierarchies, line components, component groups, stopping conditions, and high-cost outlier thresholds.
Advanced skills in claim formatting, line item rollups, modifier positioning, and alternative form baselines (ABF).
Advanced capability in configuring tolerance thresholds, auto-acceptance parameters, and automated cash-posting logic.
Full proficiency in CARC/RARC code mapping to convert electronic 835 denial codes into automated system actions.
Comprehensive build experience writing criteria rules for account routing, claim validations, and variance tracking.
Structural knowledge of Hospital Account Workqueue routing rules, team segmentations, and supervisor dashboard triggers.
Inpatient Models: DRG Base-Rates, Per Diems (by accommodation code), Case Rates, and Tiered Stop-Loss thresholds.
Outpatient Models: Ambulatory Payment Classifications (APC), Percent of Charges, and fee schedule linkages (EFT master files).
Contract Simulation: Executing "Penny Tests" via contract utilities to validate system calculations against paper matrices.
837I Electronic File Auditing: Reviewing raw text configurations in generated claim batches for compliance.
Production Pilot Launching: Executing retro-effective testing strategies on low-volume plan subsets to mitigate false-positive variance spikes.
Proficient with contract terms, outward-facing claims formatting and inward-facing payment processing
Contract Build to compute the exact Expected Reimbursement and establish initial patient liability when billing is initiated
Claims Build (Epic Resolute HB Claims) build ensures that information is translated into a clean 837I electronic file that matches the payor's billing rules.
Remittance Build (Epic Resolute HB Electronic Remittance) Process the 835 electronic payment file and ensure the remittance payment matches up against the contract's original expected calculation.
Mitigating Underpayment & Denial Workflows - integrate your BCC Contract calculations with Remittance (RMO) and Account Workqueues (WQV).
Excellent verbal and written English communication skills and the ability to interact professionally with a diverse group are required.

Responsibilities

Build, maintain, and model complex commercial and government payor contracts within the Epic BCC master file using advanced rule logic (CER).
Configure Remittance Options Profiles (RMO) and automated workqueues (WQV) to intercept, flag, and route payment variances and underpayments for manual audit.
Maintain and update Claim Definition Files (CDF) to ensure outbound 837I files precisely format modifiers, codes, and rollups according to payor-specific adjudication rules.
Map Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) within the VCH master file to automate denial routing and minimize manual cash-posting touches.
Lead the end-to-end onboarding of new payor contract portfolios, executing strict regression testing, simulation modelling, and production pilot phases.
Setting Up a Brand New Payer Contract Portfolio
Testing and Validation Strategy