Medical Group, Contract Definition Analyst

Location: United States; remote work available

Salary: $63,964–$110,872 base pay annually, plus variable pay opportunity.

Company

hirify.global is a global data and technology company operating across financial services, healthcare, automotive, agribusiness, insurance, and other markets.

What you will do

• Analyze and define medical group contracts for Medicare, Medicaid, Workers' Compensation, Medicare Advantage, Managed Medicaid, and commercial payers.
• Interpret payer contracts, fee schedules, reimbursement provisions, and supporting documentation for system configuration.
• Apply RBRVS, fee schedules, carve-outs, drug, DME, and laboratory pricing methodologies.
• Research CMS, state Medicaid, and commercial payer resources, including reimbursement policies, claim processing guidelines, and payer edits.
• Validate and troubleshoot claim and patient estimate valuations, investigate discrepancies, and resolve valuation-related support cases.
• Participate in client and internal meetings and contribute to quality and process improvement initiatives.

Requirements

• 4+ years of healthcare industry experience involving professional or medical group payer contracts, reimbursement, billing, claims management, or adjudication.
• 4+ years of experience with professional reimbursement methodologies, including RBRVS and physician fee schedules.
• Experience with carve-outs, drug, DME, laboratory pricing, and payer-specific reimbursement arrangements.
• Experience with claim processing guidelines, payer edits, and professional coding conventions, including CPT, HCPCS, modifiers, place of service, and ICD-10 diagnosis codes.
• Advanced Excel expertise, including complex functions.
• A bachelor's degree in Healthcare Administration, Business Administration, or a related field is beneficial; experience with Contract Manager or similar healthcare contract modeling applications is also beneficial.

Culture & Benefits

• Flexible work environment with the ability to work remotely.
• Medical, dental, and vision coverage with matching 401(k).
• Compensation package with a bonus plan and variable pay opportunity.
• Flexible time off, including volunteer time off, vacation, sick leave, and 12 paid holidays.
• Inclusive, purpose-driven culture across a global workforce.