Sidecar Health
Pricing Configuration Specialist
Job Summary
The Pricing Configuration Analyst is responsible for maintaining and implementing claims database information, working closely with cross-functional teams to ensure accurate updates to payment systems and pricing modules. The role involves troubleshooting coding and grouping issues, interpreting CMS pricing rules, and collaborating with various teams on training and documentation. Candidates should have at least 3 years of experience with PPS coding and healthcare billing practices, along with strong analytical and communication skills. The position offers competitive compensation, comprehensive benefits, and opportunities to contribute to healthcare transformation initiatives.
Required Skills
Benefits
Job Description
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
Sidecar Health is an Equal Opportunity employer committed to building a diverse team. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.
Sidecar Health
Looking for a new kind of health insurance? Sidecar Health offers transparent & affordable health insurance for individuals, and you can choose any doctor you like. Learn more.
See more jobsSafe Remote Job Search Tips
Verify Employer Thoroughly
Research the company's identity thoroughly before applying. Check for a professional website with contacts, active social media, and LinkedIn profiles. Verify details across platforms and look for reviews on Glassdoor or Trustpilot to confirm legitimacy.
Never Pay to Get a Job
Legitimate employers never require payment for applications, training, background checks, or equipment. Always reject upfront payment requests or demands for bank details, even if they claim it's for purchasing necessary work gear on your behalf.
Safeguard Your Personal Information
Protect sensitive data like SSN, bank details, or ID copies. Share this only after accepting a formal, written job offer. Ensure it's submitted via a secure company system or portal, never through insecure channels like standard email attachments.
Scrutinize Communication & Interviews
Watch for communication red flags: poor grammar, generic emails (@gmail), vague details, or undue pressure. Be highly suspicious of interviews held only via text or chat apps; legitimate companies typically use video or phone calls.
Beware of Unrealistic Offers
If an offer's salary or benefits seem unrealistically high for the work involved, be cautious. Research standard pay for similar roles. Offers that appear 'too good to be true' are often scams designed to lure you into providing information or payment.
Insist on a Formal Contract
Always secure and review a formal, written job offer or employment contract before starting work or sharing final personal details. Ensure it clearly defines your role, compensation, key terms, and conditions to avoid misunderstandings or scams.