Full-Time Hospital Contract Definition Analyst (Remote)

• Ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates.
• Collaborate with senior team members to process new client implementations.
• Independently manage routine maintenance cases, ensuring compliance with enterprise standards and client expectations.

Key Responsibilities:

• Use extensive knowledge of reimbursement methodologies to analyze, define, and maintain hospital payer contracts (Medicare, Medicaid, Workers Compensation, Commercial Payers).
• Analyze and interpret complex contract provisions and reimbursement rates.
• Research payer websites and regulatory sources to stay current on adjudication rules and reimbursement policies.
• Validate system-generated valuations against client-submitted claims and estimates.
• 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 initiatives aimed at reducing manual effort and enhancing data accuracy.

Qualifications:

• 3+ years' experience in the hospital industry, with direct involvement in payer contracts and facility reimbursement methodologies.
• 2+ years' direct experience with hospital billing, claims management, and payer contracting.
• 2+ years' in-depth knowledge of facility reimbursement models.
• 2+ years' proficiency in coding systems (CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, ICD-10).
• Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration preferred.

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