Contract Definition Analyst - Hospital Definition Specialty

Role description

Contract Definition Analyst - Hospital Definition Specialty

Lead II - BPM

Who We Are:

Born digital, UST transforms lives through the power of technology. We walk alongside our clients and partners, embedding innovation and agility into everything they do. We help them create transformative experiences and human-centered solutions for a better world.

UST is a mission-driven group of 29,000+ practical problem solvers and creative thinkers in more than 30 countries. Our entrepreneurial teams are empowered to innovate, act nimbly, and create a lasting and sustainable impact for our clients, their customers, and the communities in which we live.

With us, you'll create a boundless impact that transforms your career-and the lives of people across the world.

Visit us at UST.com.

You Are:

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

The opportunity:

* Uses extensive knowledge of reimbursement methodologies to analyze, define, and maintain hospital payer contracts including Medicare, Medicaid, Workers Compensation, and Commercial Payers using Customer's Health 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 (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 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.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.

What you need :

* High School diploma or G.E.D. required.

* Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration preferred.

* Experience and Skills

* Minimum of 4 years of experience in the hospital industry, with direct involvement in payer contracts, facility reimbursement methodologies, and adjudication rules.

* 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.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.

Role Location: Remote - US

Compensation Range : $55,000-$83,000

Benefits

Full-time, regular employees accrue a minimum of 10 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave and jury duty. They are eligible to participate in the Company's 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid Employee Only benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses as allowable under IRS guidelines. Benefits offerings vary in Puerto Rico.

Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) Retirement Plan with employer matching.

Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company's 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.

Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).

All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.

What we believe:

We proudly embrace the values that have shaped UST since day one. We build our culture of Humility, Humanity, and Integrity. These values inspire us to nurture a people-first, human centric culture that fosters diversity, prioritizes sustainable solutions, and keeps our people and clients at the forefront of all decisions.

Humility:

We will listen, learn, be empathetic and help selflessly in our interactions with everyone.

Humanity:

Through business, we will better the lives of those less fortunate than ourselves.

Integrity:

We honor our commitments and act with responsibility in all our relationships.

Equal Employment Opportunity Statement

UST is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and "fair chance" ordinances.

UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

#UST

#CB

#LI-DU

#LI-Remote

Skills

claims adjudication,healthcare administration,claims management,customer service,

Benefits
Compensation range: $ 55,000.00 to 83,000.00 per year