Hospital Contract Definition Analyst, Healthcare
Job Description
- Use knowledge of reimbursement methodologies to analyze, define and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using Experian Health's Contract Manager software
- Analyze complex contract provisions and reimbursement rates submitted by clients to identify all necessary terms for accurate system configuration
- Research payer websites and regulatory sources (CMS, state Medicaid, commercial payers) to stay current on adjudication rules and reimbursement policies
- Validate (and troubleshoot) system-generated valuations against client-submitted claims and estimates, reconciling discrepancies due to 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 aimed at reducing manual effort and enhancing 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
- Learn new and changing reimbursement methodologies and underlying logic
- Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration or equivalent experience Benefits
- Great compensation package and bonus plan
- Core benefits including medical, dental, vision, and matching 401K, and life and disability insurance
- Family leave
- Flexible work environment, ability to work remote, hybrid or in-office
- Flexible time off including volunteer time off, vacation, sick and 12-paid holidays Apply To this Job