Offer summary

Qualifications:

Bachelor’s degree in a relevant field., Over 3 years of experience with PPS coding, DRG grouping, and APC payment methodology., Strong analytical skills with the ability to interpret complex data., Knowledge of healthcare benefits, contracts, and fee schedules..

Key responsibilities:

Maintain and update claims databases and pricing modules.

Troubleshoot coding and grouping issues related to claims.

Partner with teams to develop training and documentation on pricing rules.

Support claims processing and ensure compliance with CMS regulations.

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.

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