Job Description

The Pricing and Benefits Configuration Analyst plays a crucial role in ensuring the accurate and timely implementation and maintenance of critical information on claims databases, working closely with cross-functional teams to ensure timely and accurate updates to system and pricing modules used for payment of claims.

Responsibilities

• Coordinate and maintain PPS configuration and/or external system pricer/grouper upgrades
• Troubleshoot coding/grouping issues
• Serve as subject matter expert related to CMS pricing rules
• Partner with training teams to build documentation
• Perform root cause analysis on claim and system issues
• Partner with actuarial team on internal pricing methodology
• Support claims production teams
• Implement and maintain accurate information on claims databases
• Remain current on CMS pricing rules and regulations
• Interpret state and federal benefits and contracts
• Code, update, and maintain provider contracts and fee schedules

Requirements

• 3+ years of experience with PPS coding, DRG Grouping & APC Payment methodology
• Bachelor’s degree
• Strong analytical skills
• Experience working with industry standard groupers (3M, Optum, etc)
• Knowledge of healthcare benefits and fee schedules
• Excellent communication and interpersonal skills
• Ability to work independently and in a team

Benefits

• No benefits