Senior Contract Analyst

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

📋 Description

• Act as the primary authority for payer-provider contracts and reimbursement policies that support outpatient and specialty audit initiatives.

• Confirm contract versions, amendments, fee schedules, and effective dates prior to audits.

• Develop and sustain a contract inventory featuring version control, renewal tracking, and audit trails.

• Detect missing, expired, or outdated contracts and lead efforts for resolution.

• Examine contracts and summarize audit opportunities, including carve-out payments, provisions for implants and devices, high-cost drug terms, stop-loss and outlier thresholds, lesser-of language, bundling and packaging rules, and exclusions.

• Convert contract language into documentation that auditors can apply consistently.

• Highlight ambiguous or conflicting language and escalate proposed interpretations.

• Keep the payer reimbursement policy library updated and monitor changes, retirements, and effective dates.

• Identify policy gaps and maintain connections between concepts, policies, and clients.

• Manage the outpatient and specialty concept matrix for each client, encompassing active, paused, or excluded concepts.

• Define the matrix update schedule, change control procedures, and quality assurance checks.

• Provide reports regarding concept coverage gaps and opportunities for expansion.

• Collaborate with Client Success teams to acquire updated contracts and policies from clients.

• Monitor outstanding client requests until resolution is achieved.

• Relay contract, policy, and concept updates to audit teams.

• Recognize process enhancements and support the scaling of contract intake and abstraction workflows.

⛳️ Requirements

• Bachelor's degree or equivalent professional experience.

• Over 5 years of experience in healthcare payment integrity, provider contracting, managed care, claims auditing, or revenue cycle management.

• Proven ability to read, interpret, and abstract terms of payer-provider contracts and reimbursement methodologies.

• Strong understanding of outpatient reimbursement, including OPPS/APC, fee schedules, percentages of charges, and carve-out structures.

• Familiarity with payer reimbursement policies and the capacity to connect policy language to audit concepts.

• Experience with AI tools like Claude for conducting research on contracts, policies, and payers.

• Proficient in Excel with advanced skills in creating and managing complex tracking tools or matrices.

🏝️ Benefits

• Equal employment opportunity workplace.

• Employment at will.

• Reasonable accommodation available during the application or recruitment process.

• E-Verify participation as required by applicable law.