Senior Contract Definition Analyst - Healthcare (Remote)

Company Description

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.

• Use extensive knowledge of reimbursement methodologies to analyze, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using Experian Health's Contract Manager software.
• Analyze and interpret 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 in alignment with 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 alignment and issue resolution.
• Contribute to process improvement initiatives aimed at reducing manual effort and enhancing data accuracy.

• 4+ years' experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules.
• Familiarity with hospital billing, claims management, and payer contracting.
• In-depth knowledge of facility reimbursement models used by commercial payers, Medicare, and Medicaid for both inpatient and outpatient services.
• 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 preferred.

• 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://yourexperianbenefits.com/cand-index.html