Hospital Contract Definition Analyst, Healthcare (Remote)

Experian

1d • Remote

About The Position

As Hospital Contract Definition Analyst, you'll play 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. You will report to the Senior Director, Client Training & Contract Definition.

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
• Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration or equivalent experience

Responsibilities

• Use knowledge of reimbursement methodologies to analyze, 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, and life and disability insurance
• Family leave
• 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
• Number of Employees: 501-1,000 employees