Hospital Contract Definition Analyst, Healthcare

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 softwareAnalyze complex contract provisions and reimbursement rates submitted by clients to identify all necessary terms for accurate system configurationResearch payer websites and regulatory sources (CMS, state Medicaid, commercial payers) to stay current on adjudication rules and reimbursement policiesValidate (and troubleshoot) system-generated valuations against client-submitted claims and estimates, reconciling discrepancies due to data entry errors or policy interpretationEnsure contract terms are accurate and implemented according to client intent and payer agreementsRespond to valuation-related support cases within defined Service Level Agreement timeframesParticipate in internal and client meetings to support project agreement and issue resolutionContribute to process improvement aimed at reducing manual effort and enhancing data accuracy3+ years' experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules2+ 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 services2+ years' proficiency in coding systems including CPT, HCPCS, DRG, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis and Procedure CodesLearn new and changing reimbursement methodologies and underlying logicBachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration is beneficialBenefits/Perks:Great compensation package and bonus planCore benefits including medical, dental, vision, and matching 401KFlexible work environment, ability to work remoteFlexible time off including volunteer time off, vacation, sick and 12-paid holidaysExplore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.htmlAt Experian, our people and culture set us apart. We're deeply committed to creating an environment where everyone feels they belong and can excel. From inclusion and authenticity to work/life balance, development, wellness, collaboration, and recognition, we focus on what truly matters. Our people-first approach has earned us global recognition: World's Best Workplaces™ 2024 (Fortune Top 25), Great Place To Work™ 2025 in 26 countries, and Glassdoor Best Places to Work 2024, among others.Want to see what life at Experian is really like? Explore Experian Life on social or visit our careers site.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.Experian is a global data and technology company, powering opportunities for people and businesses around the world. We help to redefine lending practices, uncover and prevent fraud, simplify healthcare, create digital marketing solutions, and gain deeper insights into the automotive market, all using our unique combination of data, analytics and software. We also assist millions of people to realise their financial goals and help them to save time and money.We operate across a range of markets, from financial services to healthcare, automotive, agrifinance, insurance, and many more industry segments.We invest in people and new advanced technologies to unlock the power of data and to innovate. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 23,300 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com.Originally posted on Himalayas