Experian is a global data and technology company, powering opportunities for people and businesses around the world. We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more. Experian invests in people and new advanced technologies to unlock the power of data. We have an amazing team of 25,200 people in 32 countries.
The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system.
You will ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates and collaborate with senior team members to process new client implementations and independently manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations.
- Use knowledge of reimbursement methodologies to analyze, as well as, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using Experian Health's Contract Manager software
- Analyze complex contract provisions and reimbursement rates submitted by clients to identify all necessary terms for accurate system configuration
- Research payer websites and regulatory sources (CMS, state Medicaid, commercial payers) to stay current on adjudication rules and reimbursement policies
- Validate (and troubleshoot) system-generated valuations against client-submitted claims and estimates, reconciling discrepancies due to data entry errors or policy interpretation
- Ensure contract terms are accurate and implemented according to client intent and payer agreements
- Respond to valuation-related support cases within defined Service Level Agreement timeframes
- Participate in internal and client meetings to support project agreement and issue resolution
- Contribute to process improvement aimed at reducing manual effort and enhancing data accuracy
- 3+ years' experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules
- 2+ years' direct experience with hospital billing, claims management (facilities, appeals), and payer contracting.
- 2+ years' in-depth knowledge of facility reimbursement models used by commercial payers, Medicare, and Medicaid for both inpatient and outpatient services
- 2+ years' proficiency in coding systems including CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis and Procedure Codes
- Learn new and changing reimbursement methodologies and underlying logic
- Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration is beneficial
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Our compensation reflects the cost of labor across several U.S. geographic markets. The base pay range for this position is listed above. Within this range, individual pay is determined by work location and additional factors such as job-related skills, experience, and education. You will be also eligible for a variable pay opportunity.
Experian is proud to be an Equal Opportunity Employer for all groups protected under applicable federal, state and local law, including protected veterans and individuals with disabilities. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.
Benefits/Perks:
- Great compensation package and bonus plan
- Core benefits including medical, dental, vision, and matching 401K
- Flexible work environment, ability to work remote, hybrid or in-office
- Flexible time off including volunteer time off, vacation, sick and 12-paid holidays
- Explore all our exciting benefits here: https://myexperianbenefits.com/
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Experian will never ask candidates to make any payment as part of an application, interview, assessment, onboarding, or recruitment process. To apply for roles or verify opportunities, please visit experian.com/careers