Hospital Contract Definition Analyst, Healthcare (Remote)
Experian · United States
- Hybrid
- Full-time
- $78,057 / year
- United States
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Job highlights
- Implement and maintain hospital payer contracts.
- Analyze and model reimbursement methodologies accurately.
- Collaborate on client implementations and manage maintenance.
- Research payer rules and ensure contract accuracy.
- Respond to valuation support cases and improve processes.
About the role
Job Title: Hospital Contract Definition Analyst, Healthcare
Company Description
Experian is a global data and technology company, powering opportunities for people and businesses around the world. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create digital marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. We also assist millions of people to accomplish their financial goals and help them to save time and money.
We operate across a range of markets, from financial services to healthcare, automotive, agrifinance, insurance, and many more industry segments.
We invest in people and new advanced technologies to unlock the power of data and to innovate. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 23,300 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.
Job Description
As 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 manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations. You will report to the Senior Director, Client Training & Contract Definition.
What You Will Do:
- 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
Qualifications:
- 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
Key skills/competency
- Hospital Payer Contracts
- Reimbursement Methodologies
- Contract Manager Software
- Medicare
- Medicaid
- Workers Compensation
- Commercial Payers
- Claims Management
- Billing
- CPT Codes
Skills & topics
- Hospital Contract Definition Analyst
- Healthcare Analyst
- Payer Contracts
- Reimbursement Analysis
- Contract Management
- Claims Processing
- Medical Billing
- Healthcare Administration
- Remote
- Experian
How to get hired
- Tailor your resume: Highlight your 3+ years in the hospital industry, payer contract experience, and knowledge of reimbursement models.
- Showcase billing expertise: Emphasize your 2+ years in hospital billing, claims management, and payer contracting.
- Demonstrate technical proficiency: List your experience with coding systems (CPT, HCPCS, DRG, etc.) and reimbursement software.
- Prepare for behavioral questions: Be ready to discuss problem-solving, attention to detail, and collaboration in healthcare settings.
- Research Experian's culture: Understand their commitment to data, technology, and people-first initiatives.
Technical preparation
Behavioral questions
Frequently asked questions
- What is the salary range for a Hospital Contract Definition Analyst at Experian?
- The salary range for a Hospital Contract Definition Analyst at Experian is between $57,111 and $98,993 annually. This range can vary based on your specific location and other factors like experience and education.
- Is the Hospital Contract Definition Analyst role remote at Experian?
- Yes, the Hospital Contract Definition Analyst position at Experian is a remote role, offering flexibility in your work environment.
- What are the key qualifications for Experian's Hospital Contract Definition Analyst position?
- Key qualifications include over 3 years of experience in the hospital industry with payer contracts, reimbursement methodologies, and adjudication rules. You'll also need 2+ years in hospital billing, claims management, payer contracting, and proficiency with coding systems like CPT and ICD-10. A Bachelor's degree or equivalent experience is also required.
- What type of reimbursement models does Experian's Contract Manager system handle?
- Experian's Contract Manager system handles various reimbursement models including those for Medicare, Medicaid, Workers Compensation, and Commercial Payers, for both inpatient and outpatient services.
- How can I best prepare my resume for the Hospital Contract Definition Analyst role at Experian?
- To prepare your resume, focus on quantifying your achievements related to hospital payer contracts, reimbursement analysis, and claims management. Highlight your experience with specific coding systems and any familiarity with contract management software, as detailed in the job description.
- What is Experian's approach to employee benefits and work-life balance for remote roles?
- Experian offers a comprehensive benefits package including medical, dental, vision, 401K matching, and life/disability insurance. They also provide flexible work arrangements (remote, hybrid, in-office) and flexible time off, emphasizing a people-first culture focused on work-life balance and employee well-being.
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