Sagility · 5 hours ago

Pricing Research Analyst

United States

Full-time

Remote

Mid, Senior Level

$120K/yr - $120K/yr

5+ years exp

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Responsibilities

Create and update pricing spreadsheet capturing variables from various sources to ensure current and accurate pricing is uploaded and used in claims pricing.

Autonomously and consistently research resources that would provide the data needed for current, accurate and updated regulations and pricing.

Review claims payments for inconsistencies related to reimbursement, acting as a subject matter expert for consultant questions relating to pricing.

Partner with IT team to relay formulas and necessary data to upload into the pricing software for claims review.

Partner with training to create step by step guides for end users to understand and utilize the pricing engine and claims auditing.

Qualification

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Healthcare claims auditingPricing methodologiesState MedicaidMedicareAdvanced Microsoft ExcelCertified Inpatient Coder (CIC)Documentation skills

Required

Five years of demonstrated success auditing institutional (hospital) inpatient and outpatient claims. For example (APR DRG, MS DRG, per diem, including outlier and contract as well as State carveouts) and outpatient (cost-based recoveries using cost-to-charge ratios, APC, EAPG also including outlier and contract rates as well as State carveouts) for recovery of overpayments in a consulting or provider/payer environment.

Healthcare industry experience researching State and Federal regulations to identify the pricing variables required to accurately price claims.

The ability to communicate pricing formulas in a format which the Information Technology (IT) group can utilize to build pricing engines.

Ability to document processes and work with the Documentation team to create high level audit resources for each state, claim type (inpatient vs. outpatient) and line of business that can be used by the Audit team to validate overpayments.

Strong problem solving.

Diligence in reviewing and ensuring ongoing updates to pricing variables by maintaining knowledge of State and CMS website transmittals and updates.

Excellent communication and interpersonal skills - the ability to work successfully with internal teams and external clients.

Advanced Microsoft Office skills, especially Excel and Word.

High School Degree or GED required.