Contract Definition Analyst II – 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 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 save time and money.

We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more industry segments.

We invest in people and new advanced technologies to unlock the power of data. As a FTSE 100 Index company listed on the London Stock Exchange (EXPN), we have a team of 22,500 people across 32 countries. Our corporate headquarters are in Dublin, Ireland. Learn more at experianplc.com

Job Description

At Experian Health, our employees can shape more than products – they shape the future of U.S. healthcare.

This role is remote, with 10% travel

The Contract Definition Analyst (healthcare payer experience required), reports to our Client Organization and is an important part of the Contract Definition Analyst team.

You’ll have opportunity to:

• 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 and participate in learning, including CMS, state Medicaid, and Commercial Payers
• Review client claims or estimates to verify the accuracy of valuations
• Participate in internal and client meetings
• Use knowledge of reimbursement methodologies to model payer contracts for valuing physician and hospital claims and estimates
• Audit implementations
• Respond to valuation-related support cases from clients within Experian Health’s Service Level Agreement

Qualifications

10% travel

• 2+ years’ experience in the physician and hospital industry, with direct experience in payer contracts, reimbursement, and adjudication rules for Medicare, Medicaid, and Commercial Payers
• 2+ years’ experience with physician and hospital billing, payer contracting, and claims management, claims scrubbing and applying edits for Medicare, Medicaid, and commercial payers for both hospital and physician claims
• 2+ years’ experience with Medicare adjudication methods for physician, inpatient, and outpatient hospital claims valuation
• 2+ years’ experience coding conventions and their functions: CPT and HCPCS Codes, DRG Codes, Revenue Codes, Occurrence Codes, ICD-10 Diagnosis Codes, and ICD-10 Procedure Codes
• 2+ years’ experience with Medicare and commercial valuations of physician and hospital claims

Benefits/Perks:

• 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

Additional Information

Our uniqueness is that we celebrate yours. Experian’s culture and people are important differentiators. We take our people agenda very seriously and focus on what matters; DEI, work/life balance, development, authenticity, collaboration, wellness, reward & recognition, volunteering… the list goes on. Experian’s people first approach is award-winning; World’s Best Workplaces™ 2024 (Fortune Top 25), Great Place To Work™ in 24 countries, and Glassdoor Best Places to Work 2024 to name a few. Check out Experian Life on social or our Careers Site to understand why.

Experian is proud to be an Equal Opportunity and Affirmative Action employer. Innovation is an important part of Experian’s DNA and practices, and our diverse workforce drives our success. Everyone can succeed at Experian and bring their whole self to work, irrespective of their gender, ethnicity, religion, colour, sexuality, physical ability or age. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.

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