Pricing Configuration Specialist

Job Summary

A company is looking for a Pricing Configuration Specialist who will ensure the accurate implementation and maintenance of claims databases.

Key Responsibilities

• Coordinate and maintain all prospective payment system (PPS) configurations and external system upgrades
• Troubleshoot coding/grouping issues and serve as a subject matter expert on CMS pricing rules
• Implement and maintain critical information on claims databases while supporting claims production teams

Required Qualifications

• 3+ years of experience with PPS coding, DRG Grouping, and APC Payment methodology
• Bachelor's degree
• Experience with industry standard groupers (3M, Optum, etc)
• Knowledge of healthcare benefits, contracts, and fee schedules
• Strong analytical skills with the ability to interpret complex data