Full-Time Contract Definition Analyst II - Remote

Contract Definition Analyst II - Remote

Summary

This role is remote, with 10% travel. The Contract Definition Analyst (healthcare payer experience required) reports to our Client Organization and is an important part of the Contract Definition Analyst team.

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

Requirements

• Experience: 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
• Experience: 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
• Experience: 2+ years' experience with Medicare adjudication methods for physician, inpatient, and outpatient hospital claims valuation
• Experience: 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
• Experience: 2+ years' experience with Medicare and commercial valuations of physician and hospital claims

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