Hospital Contract Definition Analyst, Healthcare

Experian

full-time

Posted on:

Location Type: Remote

Location: Remote • 🇺🇸 United States

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Salary

💰 $57,111 - $98,993 per year

Job Level

Mid-LevelSenior

About the role

  • Use extensive 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 and interpret 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 initiatives aimed at reducing manual effort and enhancing 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.
  • Learn new and changing reimbursement methodologies and underlying logic.
  • Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration preferred.
Benefits
  • 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

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard skills
reimbursement methodologieshospital payer contractscontract provisions analysissystem configurationclaims managementfacility reimbursement modelsCPT codingHCPCS codingICD-10 codingdata reconciliation
Soft skills
analytical skillsproblem-solvingcommunicationcollaborationprocess improvement