Remote Medical Group Contract Analyst – Reimbursement

Experian

United States

Hybrid

USD 66,000 - 114,000

Full time

3 days ago

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Benefits offered by this job

Flexible work environment

Remote or hybrid options

Bonus potential

Job summary

Experian Health seeks an experienced Medical Group Contract Definition Analyst to analyze and implement professional payer contracts within Contract Manager. You will model terms, support medical group claims valuations, and ensure accurate configuration of reimbursement provisions.

The role requires 4+ years in healthcare payer contracts, strong Excel, CPT/HCPCS knowledge, and familiarity with CMS guidelines. Remote/hybrid work options are available.

Qualifications

4+ years in healthcare payer contracts or similar roles.
Strong knowledge of professional reimbursement methodologies (RBRVS, fee schedules).
Experience with CPT/HCPCS coding and payer policy guidelines.

Responsibilities

Analyze and define medical group contracts for Medicare, Medicaid, and commercial payers.
Interpret contracts, fee schedules, and reimbursement provisions for system configuration.
Apply reimbursement methodologies and pricing for drugs, DME, and labs.
Research CMS and payer resources to understand policies and edits.
Validate and troubleshoot claim valuations and respond to support cases.

Skills

Advanced Excel

Contract Manager

Healthcare contracts

Payer reimbursement

CPT/HCPCS coding

Data analysis

Education

Bachelor's degree in Healthcare Administration or related field

Tools

Contract Manager

Excel (Advanced)

Job description

The role requires 4+ years in healthcare payer contracts, strong Excel, CPT/HCPCS knowledge, and familiarity with CMS guidelines. Remote/hybrid work options are available.

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