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Healthcare Contract Analyst Position
hace 2 semanas
We are a company that uses data-driven insights to simplify healthcare for all. Our mission is to make the healthcare system work better for consumers and those who work in healthcare.
Our ONE Experian Health culture is centered around making this happen. We bring together people driven by purpose and want to make a difference. Our aspiration is to have a diverse group of people and minds who collaborate often to achieve goals, embrace change, and solve problems innovatively. They are:
- **OPEN**: Have a growth mindset and collaborate with others to make things happen
- **AGILE**: Always embracing change and pushing the envelope on innovative ways to solve problems
- **EFFECTIVE**: Accountable to themselves and to others
About the Role
The Healthcare Contract Analyst plays a crucial role in monitoring contractual allowances, analyzing appeal opportunities with payers and networks, and reporting appeals performance.
Main Responsibilities:
- Implement processes for identifying under-allowed claims using software and other available tools
- Review and analyze EOBs for identified under-allowed claims
- Verify applicable contracts by reviewing EOB messages, patient ID cards, and member information for managed care plans
- Use feedback and experience to refine communication skills and tools for preparing written and telephone appeals
- Batch appeals by payer or network, CPT/HCPCS code combination, error type, or provider
- Compile and submit appeals, monitor for proper reimbursement, and track recoveries
- Establish and cultivate helpful contacts in payer or network offices
- Establish follow-up protocols with payers and networks
- Prepare monthly performance statistics regarding appeals and recoveries
- Monitor and track contractual, billing, registration, and posting errors, providing continuous feedback to the Appeals Manager
- Participate in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
- Maintain the strict confidentiality required for medical records and other data
- Participate in professional development efforts to ensure currency in managed care reimbursement trends
Requirements
We are looking for candidates with:
- High school completion and some university studies preferred
- A minimum of 1-2 years' experience working with managed care claims and appeals for health care professional services (physicians and other healthcare professionals)
- Experience in a production environment desirable but comfort in such an environment essential
- Equivalent combination of education and experience may be considered
About Us
Experian is proud to be an Equal Opportunity and Affirmative Action employer. We believe in creating a thriving, inclusive, and diverse team where people love their work and love working together. 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, ensuring we live what we believe.
