Experian

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Hospital Contract Definition Analyst, Healthcare

AnalystAnalystFull TimeRemoteTeam 10,001+Since 1996H1B SponsorCompany SiteLinkedIn

Location

United States

Posted

26 days ago

Salary

$57.1K - $99.0K / year

Bachelor Degree3 yrs expEnglish

Job Description

• Plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system • Ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates • Collaborate with senior team members to process new client implementations and independently manage routine maintenance cases • Analyze, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers • Analyze complex contract provisions and reimbursement rates submitted by clients • Research payer websites and regulatory sources to stay current on adjudication rules • Validate system-generated valuations against client-submitted claims and estimates • 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 aimed at reducing manual effort

Job 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

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

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