Healthcare Payer Contract Definition Analyst II - Experian Health - REMOTE role (work anywhere in th
Company DescriptionAt Experian Health, our employees have the opportunity to shape more than products - they shape the future of US 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.
Job DescriptionGeneral Summary of Duties:
This person has responsibility for a combination of the following:
defining and maintaining payer contracts in Experian Health's proprietary physician and hospital contract manager software.
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; audit implementations to ensure clients have provided the necessary information needed to initiate an implementation; answering valuation-related support cases from clients within Experian Health's Service Level Agreement turnaround time period, and 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 FunctionsDefine payer contracts, including Medicare, Medicaid, Workers Compensation and all Commercial Payers within Experian Health's Contract Manager softwareResearch payer websites for adjudication rules as well as continuous learning, including CMS, state Medicaid's and Commercial PayersReview client's claims or estimates to verify accuracy of valuationAttend and participate in internal and client meetings as neededEngage in process and quality improvement activities to minimize manual effortsQualificationsEducation:
Bachelor's degree or greater in related field, or equivalent combination of education and experienceExperienceMinimum 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 requiredExperience in Claims Scrubbing and application of edits for Medicare, Medicaid and commercial payers for both Hospital and PhysicianKnowledgeIn depth first-hand knowledge with Medicare adjudication methods for Physician as well as Inpatient and Outpatient hospital claims valuationDemonstrated 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 CodesKnowledge of the various types of health insurance payers:
1) Medicare, 2) Medicare Advantage Plans, 3) Commercial plans, 4) Medicaid, and 5) Medicaid Managed Care OrganizationsBroad range knowledge of different types of providers, including facility versus non-facility based valuationsDemonstrating overall healthcare reimbursement knowledge by obtaining satisfactory results on a Reimbursement ExamSkillsEngaging in deductive reasoning and critical thinkingExcellent interpersonal and customer service skillsExcellent verbal and written communication skillsExhibiting very strong attention to detail and accuracy, which is of paramount importance for roleDemonstrating excellent skills in Microsoft Office Products, specifically ExcelWorking well in a team-oriented structure to achieve goalsUnderstanding Medicare valuations of physician and hospital claims as well as commercial valuationsExcellent time management and the ability to meet aggressive, short deadlines while working independently, without supervisionStrong analytical and problem-solving skillsAbility to function well in a high-paced and at times stressful environmentPossess a learning mindset and cultivating a passion for knowledgeAdditional InformationExperian 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 and it reflects what we believe.
See our DEI work in action!If you live in Colorado, Connecticut or New York City, please contact us here for the salary range of this position (include this Job Title in your email).
In addition to a competitive base salary and variable pay opportunity, Experian offers a comprehensive benefits package including health, life and disability insurance, generous paid time off including parental and family care leave, an employee stock purchase plan and a 401(k) plan with a company match.
Experian US employees are required to be fully vaccinated for COVID-19.
Experian Careers - Creating a better tomorrow togetherFind out what its like to work for Experian by clicking here.
Estimated Salary: $20 to $28 per hour based on qualifications.
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.
Job DescriptionGeneral Summary of Duties:
This person has responsibility for a combination of the following:
defining and maintaining payer contracts in Experian Health's proprietary physician and hospital contract manager software.
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; audit implementations to ensure clients have provided the necessary information needed to initiate an implementation; answering valuation-related support cases from clients within Experian Health's Service Level Agreement turnaround time period, and 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 FunctionsDefine payer contracts, including Medicare, Medicaid, Workers Compensation and all Commercial Payers within Experian Health's Contract Manager softwareResearch payer websites for adjudication rules as well as continuous learning, including CMS, state Medicaid's and Commercial PayersReview client's claims or estimates to verify accuracy of valuationAttend and participate in internal and client meetings as neededEngage in process and quality improvement activities to minimize manual effortsQualificationsEducation:
Bachelor's degree or greater in related field, or equivalent combination of education and experienceExperienceMinimum 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 requiredExperience in Claims Scrubbing and application of edits for Medicare, Medicaid and commercial payers for both Hospital and PhysicianKnowledgeIn depth first-hand knowledge with Medicare adjudication methods for Physician as well as Inpatient and Outpatient hospital claims valuationDemonstrated 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 CodesKnowledge of the various types of health insurance payers:
1) Medicare, 2) Medicare Advantage Plans, 3) Commercial plans, 4) Medicaid, and 5) Medicaid Managed Care OrganizationsBroad range knowledge of different types of providers, including facility versus non-facility based valuationsDemonstrating overall healthcare reimbursement knowledge by obtaining satisfactory results on a Reimbursement ExamSkillsEngaging in deductive reasoning and critical thinkingExcellent interpersonal and customer service skillsExcellent verbal and written communication skillsExhibiting very strong attention to detail and accuracy, which is of paramount importance for roleDemonstrating excellent skills in Microsoft Office Products, specifically ExcelWorking well in a team-oriented structure to achieve goalsUnderstanding Medicare valuations of physician and hospital claims as well as commercial valuationsExcellent time management and the ability to meet aggressive, short deadlines while working independently, without supervisionStrong analytical and problem-solving skillsAbility to function well in a high-paced and at times stressful environmentPossess a learning mindset and cultivating a passion for knowledgeAdditional InformationExperian 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 and it reflects what we believe.
See our DEI work in action!If you live in Colorado, Connecticut or New York City, please contact us here for the salary range of this position (include this Job Title in your email).
In addition to a competitive base salary and variable pay opportunity, Experian offers a comprehensive benefits package including health, life and disability insurance, generous paid time off including parental and family care leave, an employee stock purchase plan and a 401(k) plan with a company match.
Experian US employees are required to be fully vaccinated for COVID-19.
Experian Careers - Creating a better tomorrow togetherFind out what its like to work for Experian by clicking here.
Estimated Salary: $20 to $28 per hour based on qualifications.
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