Definition Analyst - Hospital Definition Specialty

Contract Definition Analyst - Hospital Definition Specialty

The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within 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.

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

• High School diploma or G.E.D. required.
• Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration preferred.

• 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.

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.

Remote- US

$48,000-$72,000

Since 1999, UST has worked side by side with the world's best companies to make a powerful impact through transformation. Headquartered in the United States, UST is powered by technology, driven by AI, inspired by people, and led by our purpose, we partner with our clients from design to operation. Our AI-driven digital…