Hospital 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 accomplish 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.
Job Description
As Hospital Contract Definition Analyst, you'll play 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. You will report to the Senior Director, Client Training & Contract Definition.
You will:
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
Qualifications
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
Additional Information
Benefits/Perks:
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
Explore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.html
At Experian, our people and culture set us apart. We're 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 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.
#LI-Remote This is a remote position.
Employee Status: Regular
Role Type: Home
Job Posting - Salary Range: $57,111 - $98,993
Department: Healthcare
Flexible Time Off: 15 Days
Schedule: Full Time
Shift: Day Shift
Compensation: USD 57111 - USD 98993 - yearly
Apply To This Job
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 accomplish 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.
Job Description
As Hospital Contract Definition Analyst, you'll play 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. You will report to the Senior Director, Client Training & Contract Definition.
You will:
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
Qualifications
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
Additional Information
Benefits/Perks:
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
Explore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.html
At Experian, our people and culture set us apart. We're 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 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.
#LI-Remote This is a remote position.
Employee Status: Regular
Role Type: Home
Job Posting - Salary Range: $57,111 - $98,993
Department: Healthcare
Flexible Time Off: 15 Days
Schedule: Full Time
Shift: Day Shift
Compensation: USD 57111 - USD 98993 - yearly
Apply To This Job