Texas Licensed Contract Analyst

Job Summary

Utilizing extensive knowledge of reimbursement methodologies, the full-time remote Texas Licensed Contract Analyst will analyze, define, and maintain hospital payer contracts, ensuring accurate modeling of reimbursement rates and supporting the valuation of hospital claims.

Key responsibilities

• Analyze and interpret complex contract provisions and reimbursement rates for accurate system configuration
• Research payer websites and regulatory sources to stay current on adjudication rules and reimbursement policies
• Validate system-generated valuations against client-submitted claims, reconciling discrepancies as needed

Required qualifications

• High School diploma or G.E.D. required; Bachelor's degree in Healthcare Administration, Finance, Accounting, or Business Administration preferred
• Minimum of 4 years of experience in the hospital industry, specifically with payer contracts and reimbursement methodologies
• In-depth knowledge of facility reimbursement models for Medicare, Medicaid, and commercial payers
• Proficiency in coding systems including CPT, HCPCS, DRG, and ICD-10 codes
• Advanced proficiency in Microsoft Office, especially Excel