Back to jobs
New

Pricing Configuration Specialist

Remote

 

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 interfaceand 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.

Apply for this job

*

indicates a required field

Resume/CV

Accepted file types: pdf, doc, docx, txt, rtf

Cover Letter

Accepted file types: pdf, doc, docx, txt, rtf


Select...