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Healthcare Contract Definition Analyst
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Healthcare Contract Definition Analyst
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Job Description:
Implement and maintain hospital payer contracts within Experian Health's Contract Manager system
Accurately model reimbursement methodologies to support valuation of hospital claims and patient estimates
Collaborate with senior team members on new client implementations
Independently manage routine maintenance cases in accordance with enterprise standards and client expectations
Analyze, define, and maintain hospital payer contracts for Medicare, Medicaid, Workers Compensation, and Commercial Payers
Analyze complex contract provisions and reimbursement rates for accurate system configuration
Research payer websites and regulatory sources, including CMS, state Medicaid, and commercial payers
Validate and troubleshoot system-generated valuations against client-submitted claims and estimates
Reconcile discrepancies caused by 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 to reduce manual effort and enhance 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
Knowledge of hospital payer contracts, reimbursement methodologies, and adjudication rules
Ability to learn new and changing reimbursement methodologies and underlying logic
Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration is beneficial
Benefits:
Great compensation package and bonus plan
Core benefits including medical, dental, vision, and matching 401K
Flexible work environment, ability to work remote, hybrid or in-office
Flexible time off including volunteer time off, vacation, sick and 12-paid holidays