Qureos Mentor

Sidecar Health

<p></p><div><p><b>About the Role</b></p>
<p>
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.</p>
<p><b>
What You'll Do</b></p>
<ul>
<li>Coordinate and maintain all prospective payment system (PPS) configuration and/or external system pricer/grouper upgrades</li>
</ul><ul><li>Troubleshoot any coding/grouping issues as reported to determine appropriate assignment of DRG/APC</li>
</ul><ul><li>Serve as subject matter expert related to CMS pricing rules and methodologies (MS-DRG, CMG, ASC PPS, IPF PPS, IRF PPS, Professional claims)</li>
</ul><ul><li>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</li>
</ul><ul><li>Perform root cause analysis on claim and system issues</li>
</ul><ul><li>Partner with actuarial team on internal pricing methodology and updates</li>
</ul><ul><li>Support claims production teams with regard to questions around both overall process and specific claim investigations</li>
</ul><ul><li>Implement and maintain accurate and timely critical information on claims databases</li>
</ul><ul><li>Remain current on all CMS pricing rules and regulations, coding updates, changes, and issues</li>
</ul><ul><li>Interpret specific state and/or federal benefits, contracts, and additional business requirements, converting these terms to configuration parameters</li>
<li>Code, update, and maintain provider contracts, fee schedules, and various system tables through the user interface and PPS systems</li>
</ul>
<p><b>What You'll Bring</b></p>
<ul>
<li>3+ years of experience with PPS coding, DRG Grouping &amp; APC Payment methodology</li>
</ul><ul><li>Bachelor's degree</li>
</ul><ul><li>Strong analytical skills with the ability to interpret complex data</li>
</ul><ul><li>Experience working industry standard groupers (3M, Optum, etc)</li>
</ul><ul><li>Knowledge of healthcare benefits, contracts, and fee schedules</li>
</ul><ul><li>Excellent communication and interpersonal skills</li>
</ul><ul><li>Ability to work independently and as part of a team in a fast-paced environment</li>
</ul>
<p><b>What You'll Get</b></p>
<ul>
<li>Competitive salary, bonus opportunity, and equity package</li>
</ul><ul><li>Comprehensive Medical, Dental, and Vision benefits</li>
</ul><ul><li>A 401k retirement plan</li>
</ul><ul><li>Paid vacation and company holidays</li>
</ul><ul><li>Opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S</li></ul><p></p><div><p><br>
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.</p></div></div><br /> <div id='job-id'>Job Id: FeoRQ1V8+vPMN4J21JkiC9cAOiXisYxmI7Zw5fyJ0BbvlI6uSmfY8jIcKc7pLRdRUUNzqS4BmA==</div>

Pricing Configuration Specialist

Join Sidecar Health and explore 1 exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.