Job description

Provider Contract Claims Analyst

ClaimsBridge is an Arnold, Maryland based Software as a Service Healthcare Claims Processing Company. Our Celerity claims adjudication engine is an industry leading system which captures, validates and prices claims for our customers and then routes them to their desired destination. Our solutions empower claims administrators, health networks and employer groups to manage healthcare expenses.

Our go forward direction is to develop new and innovative solutions to maximize savings for our clients. We have experienced extremely high growth in the last 12 months and have very aggressive targets for the coming years.

We are looking for an experienced healthcare contract analyst who is self-motivated to review and build out contracts in our contract management system.

Job Responsibilities:

• Interpret and configure medical provider, hospital and ancillary facility contracts in our proprietary platform, ClaimsBridge Celerity. This includes system configuration of rates, benefits, fee schedules and claim editing rules as needed.
• Collaborate with provider network clients and Third Party Administrators to clarify complex or ambiguous contract language and ensure accurate implementation
• Creates testing scenarios to demonstrate efficiency of proposed configuration solutions
• Perform ongoing contract maintenance, including provider updates and fee schedule changes, including documentation for tracking of all contracts, benefit, fee schedule and claim editing rule changes for quality audit purposes
• Manage incoming claims queues and apply correct pricing methodologies (contracted rates, Medicare, Medicaid, U&C, etc.)
• Accurately price all claim types (Office, Hospital, ASC, etc.) while meeting turnaround and quality benchmarks
• Ensure compliance with established claims processing procedures and quality standards
• Communicate effectively with internal teams and clients to resolve pricing questions and document resolutions
• Contribute to product improvement efforts by identifying enhancement opportunities that boost quality and efficiency

Work Hours & Benefits This job is desired to be on our Arnold MD location, but would consider remote work for the ideal candidate. Standard Mon-Fri work week. Job includes Healthcare & Dental benefits, bonus incentives.

Qualifications/Skills:

• Proven expertise of medical and dental provider contracts, both physician, hospital and ancillary facilities.
• In-depth knowledge and experience with various rate structures, such as per diem, Medicare MS-DRG/APC, Percent of Charge, Case Rates, Stop-loss, etc.
• Strong analytical and critical-thinking mindset, with the ability to interpret complex, ambiguous, or conflicting contract language and data, break problems into logical components, and reach a defensible conclusion.
• Extensive experience with commonly used computer business applications to include but not limited to: Microsoft Word, Excel and PowerPoint
• Solid understanding of medical coding and terminology, including CPT, HCPCS, and ICD-10 codes
• Strong interpersonal organizational and analytical skills and the ability to perform under pressure within rigid time constraints, without the loss of efficiency, quality and professionalism as demonstrated by previous positions held
• Demonstrated ability to analyze situations and data to identify issues, determine points of relevance and proper course of actions**, using structured, evidence-based reasoning rather than assumption or precedent alone**
• Superior communication (written and oral), negotiations, teamwork, and organizational skills as demonstrated through previous performance, testing and/or academic background
• Ability to handle multiple priorities, solve problems independently, and deliver under pressure with professionalism and accuracy
• Ability to construct and test logical "if/then" configuration rules (e.g., rate selection hierarchies, exception logic) and anticipate downstream effects of a rule change before it is implemented
• Skilled in root-cause analysis — able to trace a pricing or configuration error back through the contract terms, system logic, and claim data to identify the true source, not just the symptom
• Comfortable applying quantitative/logical reasoning to validate configuration output (e.g., reconciling expected vs. actual claim pricing, spotting outlier results that indicate a logic or data error)
• Ability to identify gaps, inconsistencies, or logical contradictions within a single contract or across multiple contracts, and escalate or resolve them proactively

Education and Personality Requirements:

• Bachelor's degree (preferred fields: healthcare administration, finance, mathematics, or another discipline with a strong analytical/quantitative component)
• 5+ years of experience in Healthcare Claims and Contract business
• Independent Worker
• Strong logical reasoning and quantitative skills, with demonstrated ability to work through multi-step, rule-based problems methodically and reach consistent, well-supported conclusions
• Ability to own projects and solve problems
• Willing to take on projects where specific process/solution learning is required
• Intellectual curiosity and a habit of questioning assumptions — willing to dig past a surface-level answer to confirm it's correct before acting on it
• Comfortable making judgment calls when contract language is ambiguous, and able to clearly articulate the reasoning behind those calls to clients and internal teams

ClaimsBridge is a rapidly growing “startup” company. There is a constant stream of exciting and rewarding projects. As with any startup we desire dynamic individuals who are willing to take on a variety of IT tasks. Our high growth potential will create career expansion opportunities, while giving employees direct influence over the company’s success and subsequent rewards.

Job Type: Full-time

Salary: $75,000.00 - $90,000.00 per year

Job Type: Full-time

Pay: $75,000.00 - $90,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Application Question(s):

• Do you have Healthcare Contracting Experience?
• 1. Do you have at least five years of experience working with healthcare provider contracts, specifically with Medicare fee schedules for both institutional and physician claims?

a. IPPS, OPPS, RBRVS, RBP, etc.

• 2. Are you proficient in interpreting and configuring healthcare related contracts using claims or contract management systems?

a. Which systems have you used and in which are you most proficient?

• 3. Are you confident in your ability to explain complex technical contract terms and reimbursement methodologies to clients and internal teams using non-technical terminology?
• How many years of experience do you have working with healthcare contracts, specifically with medical physicians or hospitals?
• Have you worked with any healthcare payers (e.g., insurance companies, managed care organizations) in negotiating or managing provider contracts? If yes, please describe your experience.
• Do you have knowledge of healthcare provider networks and reimbursement models (e.g., Medicare rates, fee-for-service, capitation, case rates)? Please explain your experience with these models.

Ability to Commute:

• Arnold, MD 21012 (Required)

Ability to Relocate:

• Arnold, MD 21012: Relocate before starting work (Preferred)

Work Location: In person