Hospital Payer Contract Architect (Remote)

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

Benefits offered by this job

Bonus plan

Health, dental, vision + 401K match

Flexible work options (remote/ hybrid/

Flexible time off

Job summary

Experian Health is seeking a Hospital Contract Definition Analyst to manage hospital payer contracts within Contract Manager. You will model reimbursement methodologies to support hospital claim valuations and patient estimates, and collaborate on new client implementations.

You will analyze complex contract terms for Medicare, Medicaid, and commercial payers, validate system-driven valuations against client data, and ensure accurate execution aligned with payer agreements.

Qualifications

• 3+ years' experience in the hospital industry with payer contracts and adjudication rules.
• 2+ years' hospital billing, claims management, and payer contracting experience.
• 2+ years' knowledge of facility reimbursement models for payers (Medicare/Medicaid and commercial).
• Bachelor's degree in a related field is beneficial.

Responsibilities

• Use knowledge of reimbursement methodologies to define and maintain hospital payer contracts including Medicare, Medicaid, Workers' Compensation, and Commercial Payers using Contract Manager software.
• Analyze contract provisions and reimbursement rates to identify terms for accurate system configuration.
• Research CMS/state Medicaid/commercial payer policies to stay current on rules and reimbursement policies.
• Validate system valuations against client-submitted claims and estimates, and reconcile discrepancies.
• Ensure contract terms are accurate and implemented per client intent and payer agreements.
• Respond to valuation-related support cases within defined SLA timeframes.
• Participate in internal and client meetings to support project resolution and improvements.

Skills

Payer contracts

Hospital billing

Regulatory knowledge

CPT coding

Education

Bachelor's degree

Tools

Contract Manager software

Job description

Experian Health is seeking a Hospital Contract Definition Analyst to manage hospital payer contracts within Contract Manager. You will model reimbursement methodologies to support hospital claim valuations and patient estimates, and collaborate on new client implementations.

You will analyze complex contract terms for Medicare, Medicaid, and commercial payers, validate system-driven valuations against client data, and ensure accurate execution aligned with payer agreements.