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