医疗合同定义分析师 - 医院
Healthcare Contract Definition Analyst - Hospital
#### 公司简介
Experian 是一家全球数据和技术公司，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
医院合同定义分析师在 Experian Health 的 Contract Manager 系统中，负责医院付款人合同的实施和维护，发挥关键作用。
您将确保准确建模报销方法，以支持医院索赔和患者预估的估值，并与高级团队成员合作处理新客户的实施，独立管理常规维护案例，确保符合企业标准和客户期望。
- 运用对报销方法的理解，分析、定义并维护医院付款人合同，包括 Medicare、Medicaid、工伤赔偿和商业付款人，使用 Experian Health 的 Contract Manager 软件
- 分析客户提交的复杂合同条款和报销费率，识别所有必要的条款以进行准确的系统配置
- 研究付款人网站和监管来源（CMS、各州医保、商业付款人）以了解最新的裁决规则和报销政策
- 验证（并排查问题）系统生成的估值与客户提交的索赔和预估是否一致，解决因数据输入错误或政策解读导致的差异
- 确保合同条款准确无误地按照客户意图和付款人协议执行
- 在规定的服务级别协议时间内响应与估值相关的支持案例
- 参与内部和客户会议，支持项目协议和问题解决
- 为流程改进做出贡献，以减少手动工作量并提高数据准确性
#### 任职要求
- 3 年以上医院行业经验，直接参与付款人合同、机构报销方法和裁决规则
- 2 年以上直接从事医院收费、索赔管理（机构、申诉）和付款人合同的经验
- 2 年以上对商业付款人、Medicare 和 Medicaid 使用的机构报销模型的深入理解，包括住院和门诊情况
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#### 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
The Hospital Contract Definition Analyst plays 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.
- Use knowledge of reimbursement methodologies to analyze, as well as, 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 is beneficial
#### 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)