EHR Rules Specialist

EHR Rules Specialist

Location: Swift Square, Dublin 9 and Kilkenny (Hybrid)
Job type: Specified Purpose

Overview of role:

The EHR Revenue Cycle Build Team Member – Insurance Rules Specialist will play a key role in the implementation of the Cúram Electronic Health Record (EHR) system across UPMC Ireland. Reporting to the Revenue Cycle Workstream Lead, this advanced build role is responsible for translating complex Irish insurance, reimbursement, package pricing, and payment agreement requirements into reliable MEDITECH Expanse configuration. The specialist will bridge revenue cycle operations and technical system build, with particular accountability for the design, build, testing, troubleshooting, documentation, and optimisation of MIS Rules and related insurance functionality. The role will work across patient access, billing, claims, finance, clinical, and technical teams to ensure that system logic supports accurate account assignment, payer processing, reimbursement, reporting, and financial outcomes.

This is an excellent opportunity for an experienced Revenue Cycle professional who has hands-on experience building complex insurance plans, packages, reimbursement logic, or contract rules in MEDITECH Expanse or another major EHR/ERP platform and is ready to take on a specialist-level build role within a significant digital transformation programme.

Primary Duties and Responsibilities:

• Specialist Build Accountability: Insurance, MIS Rules and Reimbursement
• Design, build, maintain, optimise, and troubleshoot MIS Rules within MEDITECH Expanse.
• Translate Irish insurer requirements, organisational policies, payment agreements, package pricing structures, and reimbursement models into accurate and maintainable system configuration.
• Develop and validate rule-based automation for account assignment, insurance plan selection, billing workflows, payer processing, claims handling, and related revenue cycle activities.
• Configure and maintain Payment Agreement functionality, including the logic required to support accurate reimbursement and billing outcomes.
• Ensure MIS Rules and reimbursement configuration support accurate billing, claims, collections, financial reporting, and downstream reconciliation.
• Analyse rule execution, identify unintended outcomes or gaps, and resolve system defects affecting billing or reimbursement.
• Assess the impact of proposed rule changes across registration, scheduling, charge capture, coding, billing, claims, payment posting, collections, reporting, and financial interfaces.
• Apply disciplined configuration management, documentation, and peer-review practices to complex insurance and reimbursement build.

Qualifications & Experience:

Required
• Bachelor’s degree in Health Information Management, Healthcare Administration, Finance, Business, Information Systems, or a related field. Equivalent relevant experience will be considered.
• Minimum of 3 years’ experience in healthcare revenue cycle operations, insurance, billing, claims, reimbursement, collections, contract management, or a closely related function.
• Demonstrated experience designing or building complex insurance plans, packages, reimbursement logic, payment agreements, billing rules, or contract rules in an EHR/ERP or revenue cycle platform.
• Experience with Irish private health insurance arrangements and the operational application of insurer plans, packages, and reimbursement requirements.
• Strong understanding of healthcare billing, claims, collections, payment agreements, package pricing, contract reimbursement models, and financial reconciliation.
• Proven analytical and problem-solving capability, including the ability to trace complex rule logic, identify root causes, and validate financial outcomes.
• Ability to translate business, policy, and contractual requirements into clear system design and testable configuration.
• Strong documentation, communication, and stakeholder management skills, with the ability to work across operational, financial, clinical, and technical teams.
• Hands-on experience building Irish insurance plans and package structures in another major EHR, ERP, patient accounting, or revenue cycle platform.
• Practical knowledge of Irish insurance billing and reimbursement workflows, including how payer, plan, package, contract, and payment agreement configuration affects billing and expected reimbursement.
• The ability to learn MEDITECH Expanse configuration rapidly and apply disciplined build, testing, documentation, and defect-resolution methods.

Preferred
• Advanced hands-on experience with MEDITECH Expanse Revenue Cycle applications and MIS Rules.
• Experience configuring Payment Agreements, reimbursement methodologies, package pricing, payer contracts, or insurer-specific billing logic.
• At least 2 years’ experience supporting or leading an EHR/ERP implementation, major upgrade, or revenue cycle transformation.
• Experience with MEDITECH Expanse modules such as Registration, Scheduling, Abstracting, B/AR, Charge Capture, or Claims Management
• Experience developing test scripts and expected results for complex revenue cycle scenarios and resolving defects across integrated applications.
• Familiarity with clinical-to-financial workflow alignment, charge integrity, financial interfaces, and reporting dependencies.


This job description is intended to be an outline of the areas of responsibility. As UPMC and the post holder develop, this job description may be subject to review in light of the changing needs of the business.

Equal Opportunity Statement and Benefits

UPMC is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

At UPMC we provide a total rewards program that is not only market competitive, but fair and provides growth opportunities for all our colleagues.

Benefits – Fully paid maternity and paternity leave for new parents. Competitive Pension Plan, company funded Death in Service Benefit x 3 times. Critical Illness cover for all employees up to the age of 66.

Performance and Recognition – Rewards for performance that supports the goals and mission of UPMC through our annual ACES programme.

Work-Life Balance – Enhanced annual leave up to a maximum of 27 days. Flexible working opportunities to support you to work around external family commitments.

Development and Career Opportunities – Opportunities for each employee to reach their career goals through continued learning and/or advancement.

About UPMC

UPMC is a renowned multinational academic medical centre committed to delivering people-focused care that’s close to home. Headquartered in Pittsburgh and affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC shapes the future of health through clinical and technological innovation, research and education. UPMC expands its expertise globally, bringing world-class care across continents through its UPMC International division — an owned and operated network of hospitals and ambulatory care centres in Italy, Ireland and Croatia. UPMC International brings new access to the signature specialty services of UPMC Hillman Cancer Centre, UPMC Sports Medicine and others to more people in more places around the world.

In Ireland UPMC has provided high-quality healthcare in the South East since 2006. UPMC’s operations in Ireland now include UPMC Whitfield Hospital in Waterford, UPMC Sports Surgery Clinic in Dublin, UPMC Kildare Hospital in Clane, and UPMC Aut Even Hospital in Kilkenny. Outpatient care is available at the UPMC Carlow Outreach Centre, UPMC Hillman Cancer Centre radiotherapy locations in Waterford and Cork, UPMC The 4th Practice in Mallow, and across UPMC Sports Medicine Clinics in Dublin, Waterford, Limerick, Tipperary, Cork, and Mayo. UPMC has also established a nationwide Concussion Network. UPMC's Global Technology Operation Centre is based in Kilkenny.