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Pricing Configuration Specialist

7/7/2025

No location specified

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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