Job Description
Job Description
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.