Pricing Configuration Specialist

Remote

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Candidates must possess a Bachelor's degree and at least 3 years of experience in PPS coding, DRG Grouping, and APC Payment methodology. Experience with industry standard groupers like 3M or Optum is required, along with knowledge of healthcare benefits, contracts, and fee schedules. Strong analytical skills and excellent communication and interpersonal abilities are also necessary.

Responsibilities

The Pricing Configuration Analyst will coordinate and maintain prospective payment system (PPS) configuration and upgrades, troubleshoot coding and grouping issues, and serve as a subject matter expert on CMS pricing rules and methodologies. They will partner with training teams to develop documentation, perform root cause analysis on claim and system issues, and collaborate with the actuarial team on pricing methodology. The role involves supporting claims production teams, implementing and maintaining critical information on claims databases, staying current on CMS pricing regulations, and converting business requirements into configuration parameters. Additionally, the analyst will code, update, and maintain provider contracts, fee schedules, and system tables.

Skills

PPS coding

DRG Grouping

APC Payment methodology

CMS pricing rules

MS-DRG

CMG

ASC PPS

IPF PPS

IRF PPS

Professional claims

Root cause analysis

Provider contracts

Fee schedules

Analytical skills

Sidecar Health

Affordable health insurance with price transparency

About Sidecar Health

Sidecar Health provides health insurance plans that focus on affordability and transparency, including options compliant with the Affordable Care Act (ACA). The company allows members to see average cash prices for medical services upfront, helping them make informed decisions and avoid unexpected costs. Revenue is generated through member premiums, which cover medical expenses, while also benefiting from the difference between negotiated cash prices and premiums. Sidecar Health's goal is to empower members to take control of their healthcare expenses with straightforward and cost-effective insurance options.

El Segundo, CaliforniaHeadquarters

2018Year Founded

$319.1MTotal Funding

SERIES_DCompany Stage

Financial Services, HealthcareIndustries

201-500Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Plan

Paid Vacation

Paid Holidays

Stock Options

Company Equity

Risks

Increased competition from similar insurtech companies may erode market share.

Regulatory scrutiny on cash pay models could pose compliance challenges.

Economic downturns might reduce consumer spending on health insurance premiums.

Differentiation

Sidecar Health offers transparent pricing, empowering members with upfront healthcare cost information.

The company provides customizable plans, aligning with individual coverage needs and budgets.

Partnerships with institutions like Ohio State University enhance their fixed-price care model.

Upsides

Recent $165M Series D funding supports expansion and innovation in health insurance.

Partnership with Mark Cuban Cost Plus Drug Company lowers prescription drug costs for members.

ACA-compliant product line expansion increases market reach and consumer options.

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