Medical Group, Contract Definition Analyst

Location: United States, UNITED STATES, us, Remote

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

As the Medical Group Contract Definition Analyst, you are responsible for analyzing, implementing, and maintaining professional payer contracts within Experian Healths Contract Manager system.

You will apply knowledge of professional reimbursement methodologies and payer policies to model contract terms and support valuation of medical group claims and patient estimates.

Youll have opportunity to:

• Analyze as well as, define, medical group contracts for Medicare, Medicaid, Workers Compensation, Medicare Advantage, Managed Medicaid, and Commercial Payers.
• Interpret payer contracts, fee schedules, reimbursement provisions, and supporting documentation for accurate system configuration.
• Apply professional reimbursement methodologies, including RBRVS, fee schedules, carve-outs, drug, DME, and laboratory pricing.
• Research CMS, state Medicaid, and commercial payer resources to understand reimbursement policies, claim processing guidelines, and payer edits.
• Validate and troubleshoot claim and estimate valuations, research discrepancies and resolve.
• Respond to valuation-related support cases within established timeframes.
• Participate in client and internal meetings to clarify contract requirements and resolve issues.
• Contribute to quality and process improvement plans while maintaining current knowledge of evolving reimbursement methodologies and payer policies.

Qualifications

• 4+ years healthcare industry experience involving professional/medical group payer contracts, reimbursement, billing, claims management, or adjudication.
• 4+ years knowledge of professional reimbursement methodologies, including RBRVS and physician fee schedules.
• 4+ years experience with carve-outs, drug, DME, and laboratory pricing and payer-specific reimbursement arrangements.
• 4+ years experience with claim processing guidelines, payer edit policies, and professional coding conventions, including CPT, HCPCS, modifiers, place of service, and ICD-10 diagnosis codes.
• 4+ years Advanced Excel (can perform complex functions) expertise
• Bachelors degree in Healthcare Administration, Business Administration, or a related field is beneficial
• Experience with Contract Manager or similar healthcare contract modeling applications.

Additional Information

Our uniqueness is that we celebrate yours. Experians people first, inclusive and purpose driven culture is multi award-winning; Worlds 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
• Flexible time off including volunteer time off, vacation, sick and 12-paid holidays
• Explore all our exciting benefits here: https://myexperianbenefits.com/

Recruitment Fraud Awareness - Experians recruitment process is conducted only through authorised channels. Recruitment communications will only be sent from an @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