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.