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Pricing Configuration Analyst

Sidecar Health

Sidecar Health

IT
Remote
Posted on Thursday, June 13, 2024

Sidecar Health is redefining health insurance. Our mission is to make excellent healthcare affordable and attainable for everyone. We know that to accomplish this lofty mission, we need driven people who will make things happen.

The passionate people who make up Sidecar Health’s team come from all over, with backgrounds as tech leaders, policy makers, healthcare professionals, and beyond. And they all have one thing in common—the desire to fix a broken system and make it more personalized, affordable, and transparent.

If you want to use your talents to transform healthcare in the United States, come join us!

**Must reside in Florida, Georgia, Kentucky, Ohio, or Texas for consideration**

About the Role

The Pricing Configuration Analyst plays a pivotal role in ensuring the accurate and timely implementation and maintenance of critical information within our claims databases. You will collaborate closely with cross-functional teams to update system and pricing modules, ensuring seamless 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 a subject matter expert on CMS pricing rules and methodologies, including MS-DRG, CMG, ASC PPS, IPF PPS, IRF PPS, and professional claims
  • Partner with training and documentation teams to develop necessary training materials, policies, and procedures related to the 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 regarding 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 and APC payment methodology
  • Ability to work independently and as part of a team in a fast-paced environment
  • 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
  • Proficient in Microsoft Excel
  • Bachelor’s degree

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 adopts a market-based approach to compensation, where base pay varies depending on location and is further influenced by job-related skills and experience. The current expected salary range for this position is $80,000 - $90,000.

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.