Nina Grey
Fort Worth,Texas
Summary
Effective time management and analytical skills, detailed-oriented, problem solving, and oral and communication skills which enhances my ability to prioritize work effort and conduct thorough data analysis. Taken collectively my individual and professional attributes provides a solid foundation to analyze business requirements, maintain work databases, and build effective relationships.
Overview
8
8
years of professional experience
1
1
Certification
Work History
Epic Expected Reimbursement Contracts Analyst
Trinity Health
Livonia, MI
06.2021 - Current
- Configuration & Maintenance: Build and maintain all payer agreements and applicable fee schedules obtained through Government/Payer Publications or provided by internal Payer Strategy teams
- Reviews the agreements & language for any reimbursement terms and rate policies, determines the various methodology utilized to calculate reimbursement & develops a build plan for Epic configuration
- Builds terms, fee schedules, components, selection extensions, & pricing extensions
- Inpatient Rehab and Skilled Nursing contract build experience
- Make updates based on ongoing negotiations and regular payer updates, actively monitor government or payer websites
- Testing & Controls: Unit Testing for each term to confirm the system configuration
- Utilize the SUP environment with production claims to test configuration logic
- Contract build checklist & Change Management Controls process followed
Epic Expected Reimbursement Contracts Analyst
Tegria
Madison, WI
08.2023 - 01.2024
- Deep understanding of Epic HB functionality, including reimbursement contract structures, claim edits, payment variance reporting, and payer specific rules to accurately configure contracts within the system.
- Provide guidance and coaching to new or less experienced Epic HB users, particularly in areas of contract creation, testing, and ongoing maintenance.
- Facilitate knowledge transfer by conducting training sessions, creating documentation, and sharing best practices within the team.
- Assist team members with complex contract scenarios, troubleshooting issues related to reimbursement calculations, and identifying potential areas for improvement in contract configuration.
Government Payer Analyst
Ardent Health Services
Nashville, TN
11.2018 - 06.2021
- Responsible for loading and updating Medicare/Tricare toolkits, factors and contracts in Epic’s healthcare contract manager application
- Analyze Commercial and Government provider/payer contracts and translate reimbursement terms into logic modules within the Epic’s healthcare contract manager application
- Perform additional duties as assigned
Contract specialist
Healthcare Management Solutions (HMS)
Irving, TX
05.2018 - 11.2018
- Analyze and catalogue client-provider contracts to identify pertinent contract terms that drive claim payments
- Responsible for the capturing of all relevant provider contract terms into the nThrive’s contract modeling software, and identifying new trends with a clients’ provider contracting language
- Responsible for responding to all related requests promptly and completing reporting requirements in a timely manner
- Ensure provider contract fee schedules and other payment terms are entered into the contract modeling software
- Ensure audit rights and lookback periods are entered into the contract modeling software
- Work with auditors to identify provider contract terms that make claims vulnerable for overpayment
- Work with software developers to enhance the contract modeling software and incorporate emerging industry contracting trends
- Serve as a knowledge resource to the Claim Edits and Analytics team
- Prepare reports and presentations that show findings of contract activities
Contract Analyst
NThrive
Alpharetta, GA
01.2017 - 05.2018
- Analyze provider/payer contracts and translate reimbursement terms into logic modules within the nThrive’s healthcare contract manager application
- Conduct implementations and updates of maintenance contracts including but not limited to rate updates and fee schedule updates
- Has an understanding of Government and commercial payer reimbursement methodologies
- Communicate with colleagues and customers in a clear and professional manner via phone, email, customer service ticketing systems, and in person
Education
M.B.A. - Business Administration
texas woman’s university
B.s. - Business Administration
Paul quinn college
Certification
- Resolute Hospital Billing Expected Reimbursement Contracts
- Resolute Professional Billing Expected Reimbursement Contracts
- Certified Revenue Cycle Representative (CRCR)
Timeline
Epic Expected Reimbursement Contracts Analyst
Tegria
08.2023 - 01.2024
Epic Expected Reimbursement Contracts Analyst
Trinity Health
06.2021 - Current
Government Payer Analyst
Ardent Health Services
11.2018 - 06.2021
Contract specialist
Healthcare Management Solutions (HMS)
05.2018 - 11.2018
Contract Analyst
NThrive
01.2017 - 05.2018
M.B.A. - Business Administration
texas woman’s university
B.s. - Business Administration
Paul quinn college