SBO Reimbursement Coordinator

Bay Area Hospital•Fort Bridger, WY

7d•$63,225 - $85,539

About The Position

The SBO Reimbursement Coordinator is responsible for building and maintaining the EHR contract modules in Epic for Bay Area Hospital’s Single Billing Office. The role builds and monitors payer-specific contracts, works claim variances, collaborates with payers to resolve reimbursement issues, and manages payer plan records and remit code mapping with Community Connect partners. The coordinator supports revenue cycle operations through contract analysis, testing, maintenance, variance investigation, reporting, and payer enrollment. The role also collaborates with hospital departments, external agencies, vendors, and payers; supports contract negotiations and performance improvement; and helps ensure compliance with hospital policies, laws, regulations, and payer guidelines. The position requires regular attendance at the assigned job location, flexibility in scheduling to provide user support and advance project goals, and may require off-site travel.

Requirements

High school graduation or equivalent.
Current Epic certifications or ability to obtain certification within 180 days (6 months) in Resolute Hospital Billing Expected Reimbursement Contracts Administration and Resolute Professional Billing Reimbursement Contracts.
At least five years of healthcare revenue cycle work experience, including at least two years working with hospital payer contracts, reimbursement methodologies, coding, billing, and claims.
Experience with Epic, Experian, Craneware, Optum, 3M, or other revenue cycle solutions software.
Proficient computer skills, including Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel) and WebEx, Teams, or other remote meeting/communication platforms.
Ability to understand and interpret payer contracts and research, collect, and analyze contract information.
Ability to build contracts accurately in contract management systems and Epic contract applications.
Ability to calculate and audit expected reimbursement to assess payment accuracy.
Knowledge of third-party healthcare arrangements and how to apply that knowledge.
Working knowledge of remittance codes, including CARC and RARC codes, and their potential effects on adjustments and denials.
Knowledge of 837i and 837p electronic claim formats.
Effective professional written and verbal communication, interpersonal, collaboration, problem-solving, and critical-thinking skills.
Ability to translate complex problems and concepts, work independently and as part of a team, maintain confidentiality, and exercise good judgment.
Ability to organize and prioritize multiple assignments, manage time, meet deadlines, work under stress, and adapt to changing requirements.
Ability to communicate with all levels of management and keep leadership informed of issues.
Flexibility in job schedule to provide user support and advance project goals, and regular, consistent, punctual attendance at the assigned job location.

Nice To Haves

Associate’s or bachelor’s degree.
Healthcare certification (AAHAM, NAHAM, or HFMA), Epic certification, and/or Epic training.
Project management, technical implementation, and change management experience.

Responsibilities

Interpret contract reimbursement rates and methodologies for system build.
Build and customize payer-specific contracts and reimbursement methodologies in Epic.
Test, quality-check, and document contract builds; correct errors based on user feedback.
Track contract renewals and amendments, maintain existing contracts, and build new contracts as needed.
Collaborate with payers and departments to resolve reimbursement errors, issues, and disputes.
Audit and test estimated contractual reimbursement.
Manage facility, clearinghouse payer, and remittance enrollments.
Process the monthly bad debt file from IT and low-yield accounts from accounting.
Compile daily, weekly, and monthly statistical reports for revenue cycle operations and accounts receivable management.
Evaluate material variances and trends, identify root causes, and work with health plans to resolve professional fee variances.
Analyze the financial performance of payer contracts and recommend improvement opportunities.
Model payer contracts to support proposed negotiations and identify effective rate proposals.
Collaborate with revenue cycle and hospital departments, external agencies, vendors, payers, and Community Connect partners.
Prioritize workflow, monitor performance against key performance indicators, and support organizational revenue cycle objectives.
Work with Patient Access, HIM, Revenue Integrity, and Contract Management to support revenue cycle functions and implement performance improvement plans.
Provide professional and efficient customer service and serve as a contact for reimbursement questions from clinical and non-clinical departments.
Ensure compliance with hospital policies, applicable laws and regulations, and payer guidelines.
Audit and manage collection and write-off activities and oversee third-party vendor performance for assigned work.
Plan and oversee software implementation and maintenance, and assess whether software processes meet organizational needs.
Maintain Epic payer/plan tables in collaboration with the Community Connect team.
Maintain knowledge of departmental and organizational structure, workflows, and operating procedures.
Attend assigned training, complete online training, and participate in departmental and organizational projects.
Understand emergency procedures and respond appropriately; perform other duties as assigned.