About this role
Role Overview
- Plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system
- 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 and independently manage routine maintenance cases
- Analyze, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers
- Analyze complex contract provisions and reimbursement rates submitted by clients
- Research payer websites and regulatory sources to stay current on adjudication rules
- Validate system-generated valuations against client-submitted claims and estimates
- 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
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
Benefits
- Great compensation package and bonus plan
- Core benefits including medical, dental, vision, and matching 401K
- Flexible work environment, ability to work remote
- Flexible time off including volunteer time off, vacation, sick and 12-paid holidays