Contract Definition Analyst

Hospital Contract Definition Analyst

The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within the Contract Manager system. This position ensures accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates.

Requirement/Must Have:

• High School diploma or G.E.D. required.
• Bachelor’s degree in Healthcare Administration, Finance, Accounting, or Business Administration preferred.
• Total 8 -10 years of experience.
• Minimum of 4 years experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules.

Responsibilities:

• Uses extensive knowledge of reimbursement methodologies to analyze, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using the 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 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.

Nice to Have:

• 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.
• Strong analytical, deductive reasoning, and problem-solving skills.
• Ability to adapt and learn new and changing reimbursement methodologies and underlying logic in a fast-paced environment.
• Excellent communication and customer service abilities.
• Advanced proficiency in Microsoft Office, especially Excel.
• Ability to work independently under tight deadlines in a fast-paced environment.
• Demonstrated commitment to accuracy, timeliness, and continuous learning.