医疗集团医疗合同定义分析师
Healthcare Contract Definition Analyst - Medical Group
#### 公司简介
Experian 是一家全球性的数据和技术公司，为世界各地的个人和企业创造机会。我们涉足多个市场，从金融服务到医疗保健、汽车、农业、保险等。Experian 投资于人才和先进的新技术，以释放数据的潜力。我们在 32 个国家拥有 25,200 名优秀员工。
#### 职位描述
作为 **医疗集团合同定义分析师**，你将分析、实施并维护 Experian Health 的 Contract Manager 系统中的专业支付方合同。
你将运用对专业报销方法和支付方政策的理解，对合同条款进行建模，并支持对医疗集团索赔和患者预估的估值。
**你将有机会：**
- 分析并定义 Medicare、Medicaid、工伤赔偿、Medicare Advantage、管理式 Medicaid 和商业支付方的医疗集团合同。
- 解读支付方合同、费用表、报销条款和支持文档，以确保系统配置准确。
- 应用专业报销方法，包括 RBRVS、费用表、排除项、药品、DME 和实验室定价。
- 研究 CMS、州医保和商业支付方资源，以理解报销政策、索赔处理指南和支付方编辑规则。
- 验证和排查索赔和预估的估值，研究差异并解决。
- 在规定时间内响应与估值相关的支持案例。
- 参与客户和内部会议，明确合同要求并解决问题。
- 参与质量与流程改进计划，同时保持对不断演变的报销方法和支付方政策的了解。
#### 任职资格
- 4 年以上医疗行业经验，涉及专业/医疗集团支付方合同、报销、计费、索赔管理或裁决。
- 4 年以上专业报销方法的知识，包括 RBRVS 和医生费用表。
- 4 年以上关于排除项、药品、DME 和实验室定价以及支付方特定报销安排的经验。
- 4 年以上索赔处理指南、支付方编辑政策和专业编码惯例的经验，包括 CPT、HCPCS、修饰符、服务地点和 ICD-10 诊断代码。
- 4 年以上高级 Excel（能够执行复杂函数）技能
- 学士学位
查看英文原文
#### Company Description
Experian is a global data and technology company, powering opportunities for people and businesses around the world. We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more. Experian invests in people and new advanced technologies to unlock the power of data. We have an amazing team of 25,200 people in 32 countries.
#### Job Description
As the **Medical Group Contract Definition Analyst,** you analyze, implement, and maintain professional payer contracts within Experian Health's Contract Manager system.
You will apply knowledge of professional reimbursement methodologies and payer policies to model contract terms and support valuation of medical group claims and patient estimates.
**You'll have opportunity to:**
- Analyze as well as, define, medical group contracts for Medicare, Medicaid, Workers' Compensation, Medicare Advantage, Managed Medicaid, and Commercial Payers.
- Interpret payer contracts, fee schedules, reimbursement provisions, and supporting documentation for accurate system configuration.
- Apply professional reimbursement methodologies, including RBRVS, fee schedules, carve-outs, drug, DME, and laboratory pricing.
- Research CMS, state Medicaid, and commercial payer resources to understand reimbursement policies, claim processing guidelines, and payer edits.
- Validate and troubleshoot claim and estimate valuations, research discrepancies and resolve.
- Respond to valuation-related support cases within established timeframes.
- Participate in client and internal meetings to clarify contract requirements and resolve issues.
- Contribute to quality and process improvement plans while maintaining current knowledge of evolving reimbursement methodologies and payer policies.
#### Qualifications
- 4+ years' healthcare industry experience involving professional/medical group payer contracts, reimbursement, billing, claims management, or adjudication.
- 4+ years' knowledge of professional reimbursement methodologies, including RBRVS and physician fee schedules.
- 4+ years' experience with carve-outs, drug, DME, and laboratory pricing and payer-specific reimbursement arrangements.
- 4+ years experience with claim processing guidelines, payer edit policies, and professional coding conventions, including CPT, HCPCS, modifiers, place of service, and ICD-10 diagnosis codes.
- 4+ years' Advanced Excel (can perform complex functions) expertise
- Bachelor's degree in Healthcare Administration, Business Administration, or a related field is beneficial
- Experience with Contract Manager or similar healthcare contract modeling applications.
#### Additional Information
Our uniqueness is that we celebrate yours. Experian's people first, inclusive and purpose driven culture is multi award-winning; World's Best Workplaces™ 2025 (Fortune Global Top 25), Great Place To Work™ in 26 countries to name a few. Check out Experian Life on social or explore our Careers Site to understand why.
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.
**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: [https://myexperianbenefits.com/](https://myexperianbenefits.com/)
**Recruitment Fraud Awareness**- Experian's recruitment process is conducted only through authorised channels. Recruitment communications will only be sent from an **@** [**experian.com**](http://experian.com) email address.
**Experian will never ask candidates to make any payment** as part of an application, interview, assessment, onboarding, or recruitment process. To apply for roles or verify opportunities, please visit [**experian.com/careers**](http://experian.com/careers)