Job Description

• Use 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 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 Requirements
• 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 or equivalent experience Benefits
• Great compensation package and bonus plan
• Core benefits including medical, dental, vision, and matching 401K, and life and disability insurance
• Family leave
• Flexible work environment, ability to work remote, hybrid or in-office
• Flexible time off including volunteer time off, vacation, sick and 12-paid holidays Apply To this Job