Note: The job is a remote job and is open to candidates in USA. Ellit Groups is a Private Equity-backed, woman, minority-led healthcare IT consulting firm focused on Provider and Payer organizations. The Epic HB/PB Contracts Analyst will support the client's Revenue Cycle organization by designing, building, testing, and maintaining Expected Reimbursement Contracts within Epic Resolute Hospital Billing and Professional Billing, ensuring accurate reimbursement modeling and payer contract configuration.
Responsibilities
- Build, configure, and maintain Expected Reimbursement Contracts in Epic Resolute HB and PB, including contract components, component groups, selection extensions, and pricing extensions
- Translate executed payer contracts (Medicare, Medicaid/Managed Medicaid, commercial, MCO, and government payers) into accurate Epic build supporting both hospital and professional reimbursement methodologies
- Build and maintain fee schedules (FSC 1001 import specifications and manual builds) for Medicare, Medicaid, and commercial payers, ensuring accurate pricing, timely updates, and version control
- Configure provider-based contract components — provider type, provider specialty, place of service (POS), billing entity, and modifier-driven logic — to support complex physician and facility reimbursement
- Support carve-outs, stop-loss, per diems, case rates, DRG, APC/OPPS, percent-of-charge, and value-based payment methodologies
- Perform contract modeling, variance analysis, and underpayment identification; validate expected vs. actual reimbursement using test claims and 835 remittance review
- Build and maintain Contract Review, Follow-Up, and Credit Workqueues to surface underpayments, denials, and contract variances for resolution
- Partner with PB billing, HB billing, payer contracting, managed care, and finance teams to validate reimbursement accuracy and ensure alignment with payer contracts and regulatory requirements
- Develop and execute unit, integration, and user acceptance testing (UAT); document test scripts, results, and defects
- Participate in Epic upgrades, quarterly updates, and special updates (SUs), supporting build validation, regression testing, and post-deployment support
- Migrate build through environments using Data Courier and follow enterprise Change Control and Content Management processes
- Create and maintain build documentation, contract matrices, and operational runbooks for the Contracts team
- Provide tier 2/3 production support for contract-related tickets, troubleshooting complex reimbursement issues across HB, PB, SBO, and claims workflows
- Collaborate with clearinghouse and 835/ERA teams to ensure remittance posting aligns with contract expected values
Skills
- Bachelor's degree in Health Information Management, Healthcare Administration, Business, Finance, IT, or a related field — or equivalent combination of education and experience
- 5+ years of Epic Resolute HB and/or PB analyst experience, with at least 2+ years specifically building and maintaining Expected Reimbursement Contracts
- Demonstrated experience building fee schedules, contract components, selection extensions, and pricing extensions in Epic
- Prior experience supporting a large, complex, multi-entity health system (academic medical center, IDN, or public health system)
- Experience with payer remittance (835) analysis, underpayment recovery, and variance reporting
- Deep understanding of hospital and professional reimbursement methodologies (DRG, APC/OPPS, RBRVS, per diem, case rate, percent-of-charge, carve-outs)
- Strong analytical skills with the ability to interpret payer contracts and translate terms into system build
- Excellent written and verbal communication skills; ability to interface with clinical, revenue cycle, finance, and IT stakeholders
- Strong attention to detail, documentation discipline, and ability to manage multiple concurrent contract builds
- Epic Resolute Hospital Billing Expected Reimbursement Contracts certification and/or Epic Resolute Professional Billing Expected Reimbursement Contracts certification
- Bachelor's or Master's degree in a healthcare, finance, or informatics discipline
- Experience supporting large public hospital systems or Medicaid / Managed Medicaid payer configurations
- Experience with Community Connect, Single Billing Office (SBO), and Provider-Based Billing (PBB)
- Experience integrating with third-party contract management or modeling tools
- Knowledge of state Medicaid rate codes, APGs (Ambulatory Patient Groups), and DSH/safety-net payment programs
- Proficiency with Excel, reporting tools, and Epic reporting workbench / Clarity / Caboodle (preferred)
- Resolute Hospital Billing Administration
- Resolute Professional Billing Administration
- Resolute HB or PB Claims & Electronic Remittance Administration
- Dual HB and PB Contracts certification strongly preferred
Benefits
- Competitive salary and benefits package.
- Opportunity to work in a collaborative and innovative environment.
- Professional development opportunities to advance your career.
- Flexible work arrangements to promote work-life balance.
Company Overview