Healthcare Contract Definition Analyst

🔥 14 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $65.9k - $114.2k / 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

• Implement and maintain hospital payer contracts within Experian Health's Contract Manager system • Accurately model reimbursement methodologies to support valuation of hospital claims and patient estimates • Collaborate with senior team members on new client implementations • Independently manage routine maintenance cases in accordance with enterprise standards and client expectations • Analyze, define, and maintain hospital payer contracts for Medicare, Medicaid, Workers Compensation, and Commercial Payers • Analyze complex contract provisions and reimbursement rates for accurate system configuration • Research payer websites and regulatory sources, including CMS, state Medicaid, and commercial payers • Validate and troubleshoot system-generated valuations against client-submitted claims and estimates • Reconcile discrepancies caused by 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 to reduce manual effort and enhance 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 • Knowledge of hospital payer contracts, reimbursement methodologies, and adjudication rules • Ability to learn new and changing reimbursement methodologies and underlying logic • Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration is beneficial

🏖️ Benefits

• Great compensation package and bonus plan • Core benefits including medical, dental, vision, and matching 401K • Flexible work environment, ability to work remote, hybrid or in-office • Flexible time off including volunteer time off, vacation, sick and 12-paid holidays • 15 days Flexible Time Off • Variable pay opportunity • Inclusive and purpose-driven culture