Hospital Contract Definition Analyst - Remote / Telecommute

Job Title: Hospital Contract Definition Analyst - Remote / Telecommute

Job Location: San Jose, CA

Job Type: Contract

Pay Range: $53.00hr - $58.00hr

Job Overview:

Hospital Definition Specialty Department: Contract Definition Mandatory Areas Must Have Skills Skill 1 Yrs of Exp Contract Definition Skill 2 Yrs of Exp Medical coding CPT, HCPCS, ICD Skill 3 Yrs of Exp Claims management.

The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within the client s Contract Manager system. This position ensures accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates. The analyst collaborates with senior team members to process new client implementations and independently manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations.

Key Responsibilities:

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

Education Requirements:

• 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 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.

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• Medical, Dental, and Vision Insurance
• 401(k) Retirement Plan
• Health Savings Account (HSA)
• Disability Insurance (Short-Term and Long-Term)
• Life and AD&D Insurance
• Paid Sick Leave (where required by applicable state or local law)
• Supplemental Insurance Plans
• Identity Theft Protection
• Pet Insurance
• Employee Wellness Programs
• Employee Assistance Program (EAP)
• Career Growth and Professional Development Opportunities