Strategic Hospital Payer Contract Analyst - Remote

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

Benefits offered by this job

Great compensation package and bonus

Medical, dental, vision, 401K matching

Remote/Hybrid/In-office options

Flexible time off including volunteer,

Job summary

Experian Health is seeking a Hospital Contract Definition Analyst to implement and maintain hospital payer contracts within Contract Manager. You will model reimbursement methodologies to support hospital claims and patient estimates, collaborating with senior staff on new client implementations and routine maintenance.

You will analyze contract provisions for Medicare, Medicaid, workers' compensation, and commercial payers, ensuring accurate system configuration and adherence to client

Qualifications

• 3+ years in hospital industry with payer contracts, reimbursement methodologies, and adjudication rules.
• 2+ years hospital billing, claims management, and payer contracting.
• 2+ years knowledge of facility reimbursement models for inpatient/outpatient with payers.

Responsibilities

• Model hospital payer contracts in Contract Manager software.
• Analyze contract provisions and reimbursement rates for accurate system config.
• Research CMS, Medicaid, and payer policies to stay current on rules.
• Validate system valuations against client claims and reconcile discrepancies.
• Ensure terms are accurate and align with client/payer agreements.
• Respond to valuation support cases within SLA timeframes.
• Participate in meetings to support project agreements and issue resolution.
• Contribute to process improvements to reduce manual effort and improve data accuracy.

Skills

Payer contracts

Reimbursement knowledge

Regulatory familiarity

Education

Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration

Tools

CPT/HCPCS

DRG

Revenue codes

Occurrence codes

ICD-10 codes

Job description

Experian Health is seeking a Hospital Contract Definition Analyst to implement and maintain hospital payer contracts within Contract Manager. You will model reimbursement methodologies to support hospital claims and patient estimates, collaborating with senior staff on new client implementations and routine maintenance.

You will analyze contract provisions for Medicare, Medicaid, workers' compensation, and commercial payers, ensuring accurate system configuration and adherence to client