Team Lead, Payer Contracts

Company: Experian Group
Location: Austin
Posted on: February 23, 2021

Job Description:

At Experian Health, our employees have the opportunity to shape more than products - they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better - for all of us. This person has responsibility for educating contract analysts and auditing their work through a quality assurance process, assisting with the direction of workflow, mentoring, and addressing questions before they are escalated to the manager. The team lead candidate may also be responsible for researching, analyzing, defining, loading, maintaining, and testing client contracts in Contract Manager. Analytical skills, Focus, Accuracy, and Timeliness are paramount.--

• Oversees and supports the department's quality assurance program
• Audits analysts' contract implementation and maintenance cases
• Reporting quality assurance results to management
• Be a resource/mentor for the team regarding logic, valuation, and contract definition
• Review, analyze, and define managed care contracts as well as model Medicare and Medicaid for multiple states
• Request, pursue, and thoroughly analyze contract information from contracting entities for each identified contract throughout the implementation process
• Define, load, and test contract variables
• Create mapping table which relates the Experian Healthcare contract code to the appropriate practice management system (PMS) or hospital information system (HIS) contractual identifier(s) and forward to Development
• Assist in the development of policies and procedures for contract definition
• Attend and participate in internal and client meetings as need ed Required:
  • Bachelor's degree preferred or equivalent education and experience.
  • 10 years' experience working in the healthcare industry, specifically with managed care organizations or providers
  • 2-4 years' experience working in Contract Manager
  • Strong understanding of various Physician and Hospital reimbursement methodologies (including RBRVS, St. Anthony's RBRVS, McGraw-Hill RVS, Medicare IPPS, OPPS, and ASC, APR-DRG, EAPG, Outlier/Threshold logic etc.) and claims adjudication rules and valuation logic
  • Strong interpersonal and communication skills, capable of documenting and relaying information regarding complex topics, making presentations to an internal audience and interacting positively with Experian Healthcare client base and associates
  • Understanding of Network, IPA, MSO, PCP and Contract affiliations that pertain to client specific contracts
  • Independent problem solving and self-direction are critical
  • Strong attention to detail and accuracy required
  • Advanced PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, PowerPoint, etc.)
  • Capable of learning the intricacies of using the Contract Manager application
  • The ability to embrace change, be flexible, and be project oriented
  • The ability to work in a very fast paced environment
  • HFMA or MGMA certification Experian is an Equal Opportunity Employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner. The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.
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Keywords: Experian Group, Austin , Team Lead, Payer Contracts, Other , Austin, Texas