Huron
Why Consider this Job Opportunity
Competitive salary with opportunities for performance bonuses
Potential for career advancement and professional growth within the organization
Collaborative and supportive work environment
Engage in meaningful work that impacts the healthcare landscape
Opportunity to work with cross‑functional teams including Provider Contracting, Claims, Finance, and IT
What to Expect (Job Responsibilities)
Configure and optimize provider pricing rules, fee schedules, and reimbursement logic using the NetworX Pricer platform
Analyze contract terms and translate them into systematic pricing configuration requirements
Validate pricing outcomes through test adjudication and reconcile any variances
Monitor and troubleshoot pricing-related claims issues while leading root‑cause investigations
Ensure compliance with regulatory requirements and maintain updated configuration documentation
What is Required (Qualifications)
4–7 years of hands‑on NetworX Pricer configuration experience in a health plan or TPA environment
Expertise in provider pricing methodologies such as RBRVS, APC/DRG, and value‑based reimbursement models
Strong knowledge of claims adjudication and provider contracting workflows
Ability to analyze complex pricing rules and convert them into scalable configuration logic
Excellent communication skills and attention to detail
How to Stand Out (Preferred Qualifications)
Experience in healthcare consulting or working directly with healthcare organizations
Familiarity with regulatory requirements and CMS pricing standards
Proven track record of successful collaboration with cross‑functional teams
Additional certifications related to healthcare reimbursement or pricing methodologies
We prioritize candidate privacy and champion equal‑opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter an employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top‑tier employer.
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Potential for career advancement and professional growth within the organization
Collaborative and supportive work environment
Engage in meaningful work that impacts the healthcare landscape
Opportunity to work with cross‑functional teams including Provider Contracting, Claims, Finance, and IT
What to Expect (Job Responsibilities)
Configure and optimize provider pricing rules, fee schedules, and reimbursement logic using the NetworX Pricer platform
Analyze contract terms and translate them into systematic pricing configuration requirements
Validate pricing outcomes through test adjudication and reconcile any variances
Monitor and troubleshoot pricing-related claims issues while leading root‑cause investigations
Ensure compliance with regulatory requirements and maintain updated configuration documentation
What is Required (Qualifications)
4–7 years of hands‑on NetworX Pricer configuration experience in a health plan or TPA environment
Expertise in provider pricing methodologies such as RBRVS, APC/DRG, and value‑based reimbursement models
Strong knowledge of claims adjudication and provider contracting workflows
Ability to analyze complex pricing rules and convert them into scalable configuration logic
Excellent communication skills and attention to detail
How to Stand Out (Preferred Qualifications)
Experience in healthcare consulting or working directly with healthcare organizations
Familiarity with regulatory requirements and CMS pricing standards
Proven track record of successful collaboration with cross‑functional teams
Additional certifications related to healthcare reimbursement or pricing methodologies
We prioritize candidate privacy and champion equal‑opportunity employment. Central to our mission is our partnership with companies that share this commitment. We aim to foster a fair, transparent, and secure hiring environment for all. If you encounter an employer not adhering to these principles, please bring it to our attention immediately.
We are not the EOR (Employer of Record) for this position. Our role in this specific opportunity is to connect outstanding candidates with a top‑tier employer.
#J-18808-Ljbffr