Full-timeEmployee Status: RegularRole Type: HomeJob Posting - Salary Range: $57,111 - $98,993Flexible Time Off: 15 DaysSchedule: Full TimeShift: Day ShiftJob DescriptionAs Hospital Contract Definition Analyst, you'll play a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system. You will ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates and collaborate with senior team members to process new client implementations and independently manage routine maintenance cases, ensuring compliance with enterprise standards and client expectations. You will report to the Senior Director, Client Training & Contract Definition.You will: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 softwareAnalyze complex contract provisions and reimbursement rates submitted by clients to identify all necessary terms for accurate system configurationResearch payer websites and regulatory sources (CMS, state Medicaid, commercial payers) to stay current on adjudication rules and reimbursement policiesValidate (and troubleshoot) system-generated valuations against client-submitted claims and estimates, reconciling discrepancies due to data entry errors or policy interpretationEnsure contract terms are accurate and implemented according to client intent and payer agreementsRespond to valuation-related support cases within defined Service Level Agreement timeframesParticipate in internal and client meetings to support project agreement and issue resolutionContribute to process improvement aimed at reducing manual effort and enhancing data accuracyQualifications3+ years experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules2+ years direct experience with hospital billing, claims management (facilities, appeals), and payer contracting2+ years in-depth knowledge of facility reimbursement models used by commercial payers, Medicare, and Medicaid for both inpatient and outpatient services2+ years proficiency in coding systems including CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis and Procedure CodesLearn new and changing reimbursement methodologies and underlying logicBachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration or equivalent experienceAdditional InformationGreat compensation package and bonus planCore benefits including medical, dental, vision, and matching 401K, and life and disability insuranceFamily leaveFlexible work environment, ability to work remote, hybrid or in-officeFlexible time off including volunteer time off, vacation, sick and 12-paid holidaysExperian is proud to be an Equal Opportunity Employer for all groups protected under applicable federal, state and local law, including protected veterans and individuals with disabilities. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.
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