Remote Healthcare Contract Architect

Experian; United States; Hybrid; USD 66,000 - 114,000; Full time

Job summary

Experian Health seeks a Hospital Contract Definition Analyst to implement and maintain hospital payer contracts within Contract Manager. You will model reimbursements for hospital claims and patient estimates, collaborate on client implementations, and manage routine maintenance cases to ensure compliance with enterprise standards.

You will analyze complex provisions, research CMS/Medicaid rules, validate valuations, and contribute to process improvements for accuracy and efficiency.

Qualifications

• 3+ years in hospital industry with payer contracts and adjudication rules.
• 2+ years hospital billing, claims management, and payer contracting.
• 2+ years knowledge of facility reimbursement models for inpatient/outpatient.
• 2+ years proficiency in CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, ICD-10.
• Learn new and changing reimbursement methodologies and underlying logic.
• Bachelor's degree in related field is beneficial.

Responsibilities

• Analyze hospital payer contracts (Medicare/Medicaid/Commercial) and configure in Contract Manager.
• Model reimbursements to support valuation of hospital claims and patient estimates.
• Process client implementations and maintain routine maintenance cases.
• Validate system valuations against client claims; reconcile discrepancies.
• Ensure contract terms are accurate and align with client intent and payer agreements.
• Respond to valuation-related support cases within defined SLAs.
• Participate in internal and client meetings to support project resolution.
• Contribute to process improvements to reduce manual effort and improve data accuracy.

Skills

Hospital payer contracts

Hospital billing & claims

Coding systems CPT/HCPCS/DRG/ICD-10

Regulatory adjudication rules

Reimbursement methodologies

Education

Bachelor's degree in Healthcare Admin/Finance/Accounting/Business

Job description

Experian Health seeks a Hospital Contract Definition Analyst to implement and maintain hospital payer contracts within Contract Manager. You will model reimbursements for hospital claims and patient estimates, collaborate on client implementations, and manage routine maintenance cases to ensure compliance with enterprise standards.

You will analyze complex provisions, research CMS/Medicaid rules, validate valuations, and contribute to process improvements for accuracy and efficiency.