Healthcare Contract Definition Analyst - Medical Group
Core
Analyze, implement, and maintain professional payer contracts within the Contract Manager system to model terms and support valuation of medical group claims and patient estimates.
Role type
Healthcare Contract Definition Analyst
Builds
Accurate system configurations for Medicare, Medicaid, Workers' Compensation, Medicare Advantage, Managed Medicaid, and Commercial Payer contracts.
Domain
Healthcare reimbursement and claims management
Deliverable
production ML models | product features | dashboards & analysis
Required skills
Professional reimbursement methodologies (RBRVS, fee schedules), carve-outs, drug/DME/laboratory pricing, claim processing guidelines, payer edit policies, professional coding conventions (CPT, HCPCS, modifiers, POS, ICD-10), Advanced Excel, contract modeling applications
Preferred skills
Experience with Contract Manager or similar healthcare contract modeling applications
Responsibilities
Interpret payer contracts and fee schedules for system configuration; research CMS, state Medicaid, and commercial payer resources; validate and troubleshoot claim and estimate valuations; respond to valuation-related support cases; participate in meetings to clarify contract requirements; contribute to quality and process improvement plans.
Seniority
Mid-level, hands-on IC
