Contract Pricing Configuration Analyst

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Set up and oversee provider reimbursement agreements for healthcare professionals, institutions, and ancillary services.

• Analyze and interpret company reimbursement agreements.

• Collaborate with contract managers or reimbursement leads to understand and configure contract terms.

• Conduct unit tests on straightforward configuration modifications to ensure accuracy in rate loading.

• Address internal and external provider fee inquiries.

• Resolve configuration problems highlighted by Service or Provider Relations.

• Monitor and evaluate pricing rules, fee schedules, and contract loads.

• Support internal and external audits, including SOX and SSAE16 compliance.

• Assist leadership on enterprise projects affecting pricing strategies.

⛳️ Requirements

• Strong analytical abilities related to hospitals, ancillary services, and provider contracts.

• High School Diploma/GED is mandatory.

• 3-5 years of experience in Health Care, specifically in provider contract and pricing configuration.

• Alternatively, 5 years of Health Care experience focused on provider contract and pricing configuration may substitute for a degree.

• Previous experience with one or more claims systems is required.

• Familiarity with pricing and/or provider contract agreements is essential.

• Preferred experience with NetworX Pricer and NetworX PBA.

• Preferred knowledge of one or more claims systems, particularly in claims processing, pricing, and contract setup.

• Preferred understanding of business and technical requirements.

• Preferred knowledge of claims processing systems.

• Preferred familiarity with the testing life cycle.

• Proficient in MS tools, including MS Office products, MS Access, and SQL Server.

• Exceptional verbal and written communication skills, along with strong presentation abilities.

• Client service-oriented with a capacity for empathy.

• Willingness to participate in cross-training and to train others.

• Detail-oriented with excellent organizational and data processing capabilities.

• Ability to adhere to detailed instructions.

• Strong problem-solving, analytical, and research skills.

• Quick learner with the ability to apply knowledge in new contexts.

• Adaptability to change as necessary.

• Commitment to maintaining attendance to meet the quality and quantity of work demands.

• Skills in multitasking and workload prioritization.

• Must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.