Senior Hospital Contract Definition Analyst, Healthcare

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $64k - $110.9k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

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Experian

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1996

🤖 Artificial Intelligence

🤝 B2B

☁️ SaaS

Artificial Intelligence • B2B • SaaS

Experian is a global leader in digital experience, technology, and transformation. They partner with recognized brands to enhance customer understanding, innovate product strategies, and implement agile technology solutions. With a focus on delivering superior customer experiences through AI, cloud architecture, and project management, Experian helps businesses streamline their operations and achieve their objectives effectively.

📋 Description

• 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

🎯 Requirements

• 5+ years experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules • 3+ years direct experience with hospital billing, claims management (facilities, appeals), and payer contracting • 3+ years in-depth knowledge of facility reimbursement models used by commercial payers, Medicare, and Medicaid for both inpatient and outpatient services • 3+ 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

🏖️ Benefits

• Great compensation package and bonus plan • Core benefits including medical, dental, vision, and matching 401K, and life and disability insurance • Family leave • Flexible work environment, ability to work remote, hybrid or in-office • Flexible time off including volunteer time off, vacation, sick and 12-paid holidays