Healthcare Contract Definition Analyst - Remote-Friendly

Experian; Northern (KY); Hybrid; USD 66,000 - 114,000; Full time

Benefits offered by this job

Bonus plan

Medical benefits

401K matching

Flexible work model

Paid time off

Job summary

Experian Health seeks a Healthcare Contract Definition Analyst for the Medical Group to analyze, implement, and maintain professional payer contracts within Contract Manager. You will model contract terms and support valuation of medical group claims and patient estimates.

You will define contracts for Medicare, Medicaid, Workers' Compensation, and Commercial Payers, interpreting provisions and applying reimbursement methodologies including RBRVS, fee schedules, carve-outs, drug, DME, and lab

Qualifications

• 4+ years healthcare payer contracts experience.
• 4+ years knowledge of reimbursement methodologies incl. RBRVS.
• 4+ years experience with carve-outs, drug, DME, and laboratory pricing.
• 4+ years with CPT/HCPCS/ICD-10 coding guidelines.
• Advanced Excel expertise.
• Bachelor's degree beneficial.
• Experience with Contract Manager or similar apps.

Responsibilities

• Analyze, implement, and maintain professional payer contracts.
• Model contract terms and support valuation of medical group claims.
• Interpret payer contracts, fee schedules, and documentation.
• Apply reimbursement methodologies including RBRVS, drug, DME, and lab pricing.
• Research CMS and state Medicaid payer policies.
• Validate and troubleshoot claim valuations and respond to cases.
• Participate in client and internal meetings to clarify requirements.
• Contribute to quality and process improvement and stay updated on methodologies.

Skills

Advanced Excel

Payer contracts analysis

Contract management

Healthcare reimbursement

Education

Bachelor's degree in Healthcare Administration or related field

Tools

Contract Manager

Contract modeling apps

Job description

Experian Health seeks a Healthcare Contract Definition Analyst for the Medical Group to analyze, implement, and maintain professional payer contracts within Contract Manager. You will model contract terms and support valuation of medical group claims and patient estimates.

You will define contracts for Medicare, Medicaid, Workers' Compensation, and Commercial Payers, interpreting provisions and applying reimbursement methodologies including RBRVS, fee schedules, carve-outs, drug, DME, and lab