Pricing Configuration Specialist

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!

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