Contract Definition Analyst

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $64k - $110.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Experian

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1996

💼 Consulting

📣 Marketing

📦 Logistics

Consulting • Marketing • Logistics

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

• Analyze and define medical group contracts for Medicare, Medicaid, Workers' Compensation, Medicare Advantage, Managed Medicaid, and Commercial Payers • Interpret payer contracts, fee schedules, reimbursement provisions, and supporting documentation for accurate system configuration • Apply professional reimbursement methodologies, including RBRVS, fee schedules, carve-outs, drug, DME, and laboratory pricing • Research CMS, state Medicaid, and commercial payer resources to understand reimbursement policies, claim processing guidelines, and payer edits • Validate and troubleshoot claim and estimate valuations, research discrepancies, and resolve issues • Respond to valuation-related support cases within established timeframes • Participate in client and internal meetings to clarify contract requirements and resolve issues • Contribute to quality and process improvement plans while maintaining current knowledge of evolving reimbursement methodologies and payer policies

🎯 Requirements

• 4+ years' healthcare industry experience involving professional/medical group payer contracts, reimbursement, billing, claims management, or adjudication • 4+ years' knowledge of professional reimbursement methodologies, including RBRVS and physician fee schedules • 4+ years' experience with carve-outs, drug, DME, and laboratory pricing and payer-specific reimbursement arrangements • 4+ years experience with claim processing guidelines, payer edit policies, and professional coding conventions, including CPT, HCPCS, modifiers, place of service, and ICD-10 diagnosis codes • 4+ years' Advanced Excel (can perform complex functions) expertise • Experience with Contract Manager or similar healthcare contract modeling applications • Bachelor's degree in Healthcare Administration, Business Administration, or a related field is beneficial

🏖️ Benefits

• Flexible Time Off: 15 Days • 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