Hospital Contract Definition Analyst, Healthcare (Remote)

Experian

3d • Remote

About The Position

The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system. You will ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates and collaborate with senior team members to process new client implementations and independently manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations. Use knowledge of reimbursement methodologies to analyze, as well as, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using Experian Health's Contract Manager software Analyze complex contract provisions and reimbursement rates submitted by clients to identify all necessary terms for accurate system configuration Research payer websites and regulatory sources (CMS, state Medicaid, commercial payers) to stay current on adjudication rules and reimbursement policies Validate (and troubleshoot) system-generated valuations against client-submitted claims and estimates, reconciling discrepancies due to 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 aimed at reducing manual effort and enhancing 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
• Learn new and changing reimbursement methodologies and underlying logic

Nice To Haves

• Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration is beneficial

Responsibilities

• Analyze, as well as, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using Experian Health's Contract Manager software
• Analyze complex contract provisions and reimbursement rates submitted by clients to identify all necessary terms for accurate system configuration
• Research payer websites and regulatory sources (CMS, state Medicaid, commercial payers) to stay current on adjudication rules and reimbursement policies
• Validate (and troubleshoot) system-generated valuations against client-submitted claims and estimates, reconciling discrepancies due to 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 aimed at reducing manual effort and enhancing data accuracy

Benefits

• Great compensation package and bonus plan
• Core benefits including medical, dental, vision, and matching 401K
• Flexible work environment, ability to work remote
• Flexible time off including volunteer time off, vacation, sick and 12-paid holidays

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level