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The Hospital Contract Definition Analyst plays 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 manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations.
Use knowledge of reimbursement methodologies to analyze, as well as, 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
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 is beneficial
Employment type
Full-time
Work arrangement
Yes
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