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
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