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Healthcare - Contract Analyst

  • San Antonio, TX, United States
  • May 13, 2019
Information Technology

Job Description

At Experian Health, our employees have the opportunity to shape more than products - they shape the future of U.S. 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.

This person has responsibility for a combination of the following: (1) researching, defining, and maintaining reimbursement rules and supporting data tables for use in hospital contract management software; (2) developing methods (logic) for accurately valuing inpatient & outpatient claims, with a focus on Medicare valuations; and (3) answering valuation-related support tickets from clients. Analytical skills, Focus, Accuracy, and Timeliness are paramount.

Essential Functions:
• Research and define evaluation logic primarily for Medicare hospital claims valuation, with some commercial logic on occasion as well
• Locate and research CMS hospital-reimbursement websites and occasionally commercial payer websites for adjudication rules
• Download provider manuals, reimbursement policies ,and medical policies for use in hospital and applicable commercial payer valuations
• Create and maintain a schedule of download frequencies necessary for timely and accurate valuation of claims - maintain a schedule for updates
• Manipulate fee schedules for loading into the contract management software program
• Provide internal consulting for development of Hospital Claims Scrubbing application
• Review client claims to verify accuracy of claims valuation
• Attend and participate in internal and client meetings as needed
•Engage in process and quality improvement activities to minimize manual efforts

Other duties as required. Education:
Bachelor's degree or greater in related field, or equivalent combination of education and experience

• Minimum of 3 years' experience working in the hospital industry
• Hospital billing and/or claims management background preferred
• In depth first-hand knowledge with Medicare adjudication methods for Inpatient and Outpatient hospital claims
• Demonstrated knowledge of coding conventions & the function of each: DRG Codes, Revenue Codes, Occurrence Codes, ICD-9, ICD-10, CPT and HCPCS codes
• Knowledge of the various types of health insurance payers: 1) Medicare, 2) Medicare Advantage Plans, 3) Commercial plans, 4) Medicaid, and 5) Medicaid Managed Care Organizations
• Broad range knowledge of different types of providers, including facility versus non-facility based valuations
• Demonstrating overall healthcare reimbursement knowledge by obtaining satisfactory results on a Reimbursement Exam
• Engaging in deductive reasoning and critical thinking

Experian 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