Contract Definition Analyst - Experian Health

At Experian Health, our employees have the opportunity to shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

This person has responsibility for a combination of the following:

(1) defining and maintaining payer contracts in Experian Health’s proprietary physician and hospital contract manager software.

(2) extensive understanding of reimbursement methodologies in order to be able to accurately model payer contracts in order to value physician and hospital claims and estimates;

(3) audit implementations to ensure clients have provided the necessary information needed to initiate an implementation;

(4) answering valuation-related support cases from clients within Experian Health’s Service Level Agreement turnaround time period, and

(5) other duties, such as special projects, as assigned.

Analytical skills, Focus, Accuracy, and Timeliness are paramount for this role. Requires an individual with a track record of having the internal drive and motivation to begin and continue tasks without external prodding. The business of healthcare is ever evolving and changing; the proper candidate for this role will possess a deep desire to own their learning to keep up in a fast-paced environment.

Essential Functions:
• Define payer contracts, including Medicare, Medicaid, Workers Compensation and all Commercial Payers within Experian Health’s Contract Manager software
• Research payer websites for adjudication rules as well as continuous learning, including CMS, state Medicaid’s and Commercial Payers
• Review client’s claims or estimates to verify accuracy of valuation
• Attend and participate in internal and client meetings as needed
• Engage in process and quality improvement activities to minimize manual efforts

Education:

Bachelor’s degree or greater in related field, or equivalent combination of education and experience

Experience:
• Minimum of 5 years’ experience working in the physician and/or hospital industry, specifically regarding direct experience with payer contracts, reimbursement and adjudication rules for Medicare, Medicaid and Commercial Payers.
• Physician and/or Hospital billing and/or payer contracting as well as claims management background required

• Experience in Claims Scrubbing and application of edits for Medicare, Medicaid and commercial payers for both Hospital and Physician 

Knowledge:
• In depth first-hand knowledge with Medicare adjudication methods for Physician as well as Inpatient and Outpatient hospital claims valuation
• Demonstrated knowledge of coding conventions and the function of each: CPT and HCPCS Codes, DRG Codes, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis Codes and ICD-10 Procedure Codes
• Knowledge of the various types of health insurance payers: 1) Medicare, 2) Medicare Advantage Plans, 3) Commercial plans, 4) Medicaid, and 5) Medicaid Managed Care Organizations
• Broad range knowledge of different types of providers, including facility versus non-facility based valuations
• Demonstrating overall healthcare reimbursement knowledge by obtaining satisfactory results on a Reimbursement Exam

Skills:
• Engaging in deductive reasoning and critical thinking

• Excellent interpersonal and customer service skills

• Excellent verbal and written communication skills
• Exhibiting very strong attention to detail and accuracy, which is of paramount importance for role
• Demonstrating excellent skills in Microsoft Office Products, specifically Excel
• Working well in a team-oriented structure to achieve goals
• Understanding Medicare valuations of physician and hospital claims as well as commercial valuations
• Excellent time management and the ability to meet aggressive, short deadlines while working independently, without supervision

• Strong analytical and problem-solving skills

• Ability to function well in a high-paced and at times stressful environment

• Possess a learning mindset and cultivating a passion for knowledge

Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.
EOE including Disability/Veterans

Experian is proud to be an Equal Opportunity and Affirmative Action employer. Our goal is to create a thriving, inclusive and diverse team where people love their work and love working together. We believe that diversity, equity and inclusion is essential to our purpose of creating a better tomorrow. We value the uniqueness of every individual and want you to bring your whole, authentic self to work. For us, this is The Power of YOU and it ensures that we live what we believe.