Healthcare Contract Definition Analyst

This is a fully remote position, open to applicants in California.

📋 Description

• Implement and sustain hospital payer agreements within Experian Health's Contract Manager system.

• Precisely model reimbursement methodologies to facilitate the valuation of hospital claims and patient estimates.

• Collaborate with senior team members on the implementation of new clients.

• Independently handle routine maintenance cases in line with enterprise standards and client expectations.

• Analyze, define, and manage hospital payer contracts for Medicare, Medicaid, Workers Compensation, and Commercial Payers.

• Examine complex contract provisions and reimbursement rates for correct system configuration.

• Research payer websites and regulatory sources, including CMS, state Medicaid, and commercial payers.

• Validate and troubleshoot system-generated valuations against claims and estimates submitted by clients.

• Reconcile discrepancies arising from data entry mistakes or policy interpretations.

• Ensure that contract terms are accurate and executed according to client intentions and payer agreements.

• Address valuation-related support cases within the defined Service Level Agreement timeframes.

• Participate in internal and client meetings to facilitate project agreements and resolve issues.

• Contribute to process enhancements to minimize manual effort and improve data accuracy.

⛳️ Requirements

• More than 3 years of experience in the hospital sector, specifically with payer contracts, facility reimbursement methodologies, and adjudication rules.

• Over 2 years of direct experience with hospital billing, claims management (facilities, appeals), and payer contracting.

• At least 2 years of extensive knowledge regarding facility reimbursement models utilized by commercial payers, Medicare, and Medicaid for both inpatient and outpatient services.

• A minimum of 2 years of proficiency in coding systems, including CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, and ICD-10 Diagnosis and Procedure Codes.

• Familiarity with hospital payer contracts, reimbursement methodologies, and adjudication rules.

• Capability to learn new and evolving reimbursement methodologies and their underlying logic.

• A Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration is advantageous.

🏝️ Benefits

• Competitive compensation package and bonus plan.

• Core benefits that include medical, dental, vision, and a matching 401K.

• Flexible work environment with options to work remotely, in a hybrid model, or in-office.

• Flexible time off policy including volunteer time off, vacation, sick leave, and 12 paid holidays.

• 15 days of Flexible Time Off.

• Variable pay opportunities.

• An inclusive and purpose-driven culture.