Contract Definition Analyst II

Summary

Join Experian Health and shape the future of U.S. healthcare as a Contract Definition Analyst. This remote role, with 10% travel, involves defining payer contracts (Medicare, Medicaid, Workers' Compensation, and commercial payers) using Experian Health's Contract Manager software. You will research payer websites, review client claims, participate in meetings, and use reimbursement methodologies to model payer contracts. The position requires extensive experience in physician and hospital billing, payer contracting, and claims management, along with knowledge of various coding conventions. Experian offers a competitive compensation package, core benefits, and a flexible work environment.

Requirements

• 10% travel
• 2+ years' experience in the physician and hospital industry, with direct experience in payer contracts, reimbursement, and adjudication rules for Medicare, Medicaid, and Commercial Payers
• 2+ years' experience with physician and hospital billing, payer contracting, and claims management, claims scrubbing and applying edits for Medicare, Medicaid, and commercial payers for both hospital and physician claims
• 2+ years' experience with Medicare adjudication methods for physician, inpatient, and outpatient hospital claims valuation
• 2+ years' experience coding conventions and their functions: CPT and HCPCS Codes, DRG Codes, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis Codes, and ICD-10 Procedure Codes
• 2+ years' experience with Medicare and commercial valuations of physician and hospital claims

Responsibilities

• Define payer contracts, including Medicare, Medicaid, Workers Compensation, and all Commercial Payers within Experian Health's Contract Manager software
• Research payer websites for adjudication rules and participate in learning, including CMS, state Medicaid, and Commercial Payers
• Review client claims or estimates to verify the accuracy of valuations
• Participate in internal and client meetings
• Use knowledge of reimbursement methodologies to model payer contracts for valuing physician and hospital claims and estimates
• Audit implementations
• Respond to valuation-related support cases from clients within Experian Health's Service Level Agreement

Benefits

• Great compensation package and bonus plan
• Core benefits including medical, dental, vision, and matching 401K
• Flexible work environment, ability to work remote
• Flexible time off including volunteer time off, vacation, sick and 12-paid holidays