Hospital Contract Definition Analyst

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

📋 Description

• Execute and oversee hospital payer contracts within Experian Health's Contract Manager system.

• Develop reimbursement methodologies to assist in the valuation of hospital claims and patient estimates.

• Collaborate with senior team members on implementing new client projects.

• Independently handle routine maintenance cases in alignment 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 precise system configuration.

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

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

• Resolve discrepancies resulting from data entry mistakes or policy interpretation.

• Ensure that contract terms are implemented accurately in accordance with client intentions and payer agreements.

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

• Engage in internal and client meetings for project consensus and issue resolution.

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

⛳️ Requirements

• Minimum of 3 years of experience in the hospital sector, with direct engagement in payer contracts, facility reimbursement methodologies, and adjudication rules.

• At least 2 years of direct experience in hospital billing, claims management (facilities, appeals), and payer contracting.

• Over 2 years of comprehensive knowledge of facility reimbursement models utilized by commercial payers, Medicare, and Medicaid for both inpatient and outpatient services.

• More than 2 years of expertise in coding systems including CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, and ICD-10 Diagnosis and Procedure Codes.

• Capable of learning new and evolving reimbursement methodologies and the underlying principles.

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

🏝️ Benefits

• Attractive compensation package and bonus structure.

• Core benefits including medical, dental, vision, and a matching 401K plan.

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

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

• 15 days of Flexible Time Off.

• Opportunities for variable pay.

• An inclusive and purpose-driven workplace culture.

• Support for accommodations related to disabilities or special needs.