About this role
Interpret medical rules, regulations, fee schedules, and edits that payers post. Sources include (but may not be limited to Centers for Medicare Services "CMS", State Health & Human Services Medicaid plans, Governmental payer Tricare, and all national commercial insurance plan payers that pay). You will report to Client Implementation Senior Manager.
Understand and manipulate payer data to build federal, state, and commercial coding and financial tables that support Experian Health product logic.Monitor and maintain the tables, due to unpredictable payer updates. Navigate complex and evolving regulatory scenarios.Analyze and maintain Medicaid master fee schedules.Think through situations independently and in collaboration with others.Maximize the efficiency and use of our product solutions in day-to-day operations by properly maintaining payer specific edits.Leverage internal loading systems to routinely load advanced edit tables in testing and production environments.Have an openness and willingness to support and navigate automation and AI technologies.
2-3 years of healthcare reimbursement and coding experience is preferred.Good knowledge and experience in using Salesforce, Atlassian JIRA, Microsoft 365 applications, with great proficiency in Excel and other data analytics tools.High-level knowledge of CPT, HCPCs, and ICD-10 coding language to ensure the accuracy of coding edit files.Adaptable to changing environment and workload when necessary.
Our uniqueness is that we celebrate yours. Experian's people first, inclusive and purpose-driven culture is multi award-winning; World's Best Workplaces™ 2025 (Fortune Global Top 25), Great Place To Work™ in 26 countries to name a few. Check out Experian Life on social or explore our Careers Site to understand why. Experian is also proud to be an Equal Opportunity and Affirmative Action employer. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.
Benefits/Perks:
Great compensation package and bonus planCore benefits including medical, dental, vision, and matching 401KFlexible work environment, ability to work remote, hybrid or in-officeFlexible time off including volunteer time off, vacation, sick and 12-paid holidaysExplore all our exciting benefits here: https://yourexperianbenefits.com/cand-index.htmlThis role offers the flexibility to work from home as needed.#LI-Remote This is a remote position.