Senior Contract Definition Analyst - Healthcare (Remote)

Reporting to the Health leadersip team the Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Healths Contract Manager system. You will ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates. The analyst collaborates with senior team members to process new client implementations and independently manages routine maintenance cases ensuring compliance with enterprise standards and client expectations.

Youll have opportunity to:

• Use extensive knowledge of reimbursement methodologies to analyze define and maintain hospital payer contracts including Medicare Medicaid Workers Compensation and Commercial Payers using Experian Healths Contract Manager software.
• Analyze and interpret 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 in alignment with 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 alignment and issue resolution.
• Contribute to process improvement initiatives aimed at reducing manual effort and enhancing data accuracy.

Qualifications :

• 4 years experience in the hospital industry with direct involvement in payer contracts facility reimbursement methodologies and adjudication rules.
• Familiarity with hospital billing claims management and payer contracting.
• In-depth knowledge of facility reimbursement models used by commercial payers Medicare and Medicaid for both inpatient and outpatient services.
• 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.
• Bachelors degree in Healthcare Administration Finance Accounting or Business Administration preferred.

Additional Information :

Benefits/Perks:

• Great compensation package and bonus plan
• Core benefits including medical dental vision and matching 401K
• 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: Experian our people and culture set us apart. Were deeply 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 truly matters. Our people-first approach has earned us global recognition: Worlds Best Workplaces 2024 (Fortune Top 25) Great Place To Work 2025 in 26 countries and Glassdoor Best Places to Work 2024 among others.

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  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. Innovation is an important part of Experians DNA and practices and our inclusive workforce allows everyone to succeed and bring their whole self to work. If you have a disability or special need that requires accommodation please let us know at the earliest opportunity.

  
  

  Remote Work :

  Yes

  
  

  Employment Type :

  Full-time