Menlo Ventures
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.
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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.
#J-18808-Ljbffr