Healthcare Contract Definition Analyst
Job Description:
- Implement and maintain hospital payer contracts within Experian Health's Contract Manager system
- Accurately model reimbursement methodologies to support valuation of hospital claims and patient estimates
- Collaborate with senior team members on new client implementations
- Independently manage routine maintenance cases in accordance with enterprise standards and client expectations
- Analyze, define, and maintain hospital payer contracts for Medicare, Medicaid, Workers Compensation, and Commercial Payers
- Analyze complex contract provisions and reimbursement rates for accurate system configuration
- Research payer websites and regulatory sources, including CMS, state Medicaid, and commercial payers
- Validate and troubleshoot system-generated valuations against client-submitted claims and estimates
- Reconcile discrepancies caused by data entry errors or policy interpretation
- Ensure contract terms are accurate and implemented according to client intent and payer agreements
- Respond to valuation-related support cases within defined Service Level Agreement timeframes
- Participate in internal and client meetings to support project agreement and issue resolution
- Contribute to process improvement to reduce manual effort and enhance data accuracy
Requirements:
- 3+ years' experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules
- 2+ years' direct experience with hospital billing, claims management (facilities, appeals), and payer contracting
- 2+ years' in-depth knowledge of facility reimbursement models used by commercial payers, Medicare, and Medicaid for both inpatient and outpatient services
- 2+ years' proficiency in coding systems including CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis and Procedure Codes
- Knowledge of hospital payer contracts, reimbursement methodologies, and adjudication rules
- Ability to learn new and changing reimbursement methodologies and underlying logic
- Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration is beneficial
Benefits:
- Great compensation package and bonus plan
- Core benefits including medical, dental, vision, and matching 401K
- Flexible work environment, ability to work remote, hybrid or in-office
- Flexible time off including volunteer time off, vacation, sick and 12-paid holidays
- 15 days Flexible Time Off
- Variable pay opportunity
- Inclusive and purpose-driven culture
