Senior Hospital Contract Definition Analyst, Healthcare

🕒 vor 4 Tagen

🇺🇸 Vereinigte Staaten – Remote

💵 $63.964 - $110.872 / Jahr

⏰ Vollzeit

🟠 Senior

🧐 Analyst

🦅 H1B-Visum-Sponsor

Dieses Unternehmen hat in der Vergangenheit H1B-Visa gesponsert.

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Experian

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10.000+ Mitarbeiter

Gegründet 1996

🤖 Künstliche Intelligenz

🤝 B2B

☁️ SaaS

Artificial Intelligence • B2B • SaaS

Experian entfesselt die Kraft der Daten, um Chancen für Verbraucher, Unternehmen und die Gesellschaft zu schaffen. In den großen Momenten des Lebens – vom Kauf eines Hauses oder Autos über das Studium eines Kindes bis hin zum exponentiellen Wachstum eines Unternehmens durch die Vernetzung mit neuen Kunden – befähigen wir Verbraucher und unsere Kunden, Daten mit Zuversicht zu verwalten, damit sie jede Gelegenheit maximal nutzen können.

Beschreibung

• 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

🎯 Anforderungen

• 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

🏖️ Vorteile

• 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