Sidecar Health

Pricing Configuration Specialist

Remote

Not SpecifiedCompensation
Mid-level (3 to 4 years)Experience Level
Full TimeJob Type
UnknownVisa
Healthcare, Health InsuranceIndustries

Pricing Configuration Analyst

Position Overview

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.

Responsibilities

  • 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.

Requirements

  • 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.

Company Information

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.

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.

Land your dream remote job 3x faster with AI