Pricing Configuration Specialist

About the Role  

The Pricing Configuration Analyst plays a crucial role in ensuring the accurate and timely implementation and maintenance of critical information on our claims databases. This individual will work closely with cross-functional teams to ensure timely and accurate updates to system and pricing modules used for payment of claims. 

What You'll Do  

• Coordinate and maintain all prospective payment system (PPS) configuration and/or external system pricer/grouper upgrades 

• Troubleshoot any coding/grouping issues as reported to determine appropriate assignment of DRG/APC 

• Serve as subject matter expert related to CMS pricing rules and methodologies (MS-DRG, CMG, ASC PPS, IPF PPS, IRF PPS, Professional claims)  

• Partner with training and documentation teams to build necessary training, policy and procedure documentation as it relates to implementation and use of external pricers/groupers and exception handling 

• Perform root cause analysis on claim and system issues 

• Partner with actuarial team on internal pricing methodology and updates 

• Support claims production teams with regard to questions around both overall process and specific claim investigations 

• Implement and maintain accurate and timely critical information on claims databases  

• Remain current on all CMS pricing rules and regulations, coding updates, changes, and issues 

• Interpret specific state and/or federal benefits, contracts, and additional business requirements, converting these terms to configuration parameters  
• Code, update, and maintain provider contracts, fee schedules, and various system tables through the user interface and PPS systems 

What You'll Bring  

• 3+ years of experience with PPS coding, DRG Grouping & APC Payment methodology 

• Bachelor’s degree  

• Strong analytical skills with the ability to interpret complex data  

• Experience working industry standard groupers (3M, Optum, etc)  

• Knowledge of healthcare benefits, contracts, and fee schedules  

• Excellent communication and interpersonal skills  

• Ability to work independently and as part of a team in a fast-paced environment  

What You'll Get  

• Competitive salary, bonus opportunity, and equity package     

• Comprehensive Medical, Dental, and Vision benefits   

• A 401k retirement plan   

• Paid vacation and company holidays   

• Opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S  

Sidecar Health is an Equal Opportunity employer committed to building a diverse team. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.