Job Description

The Pricing Analyst is responsible for designing, configuring, testing, implementation and maintenance of HealthRules Payor Pricing, claims and/or benefit configuration, according to business requirements, to support accurate and efficient claims processing and data reporting to meet the needs of the Company. Investigate and resolve configuration-related provider, member and claim processing issues and assist other departments in understanding HealthRules Payor Pricing configuration. Lead and/or be part of complex HealthRules Payor Pricing Implementation and/or configuration projects. This position must possess strong analytical skills, with the ability to perform complex business rules set up in a fast-paced environment. The Configuration Analyst serves as a subject matter expert (SME) on customer projects that require configuration modifications within the claims processing system

Long Description

Responsibilities:

• Design, Develop, Configure and Test HealthRules Payor Pricing configuration, contracts, products, and policies to Implement HealthRules Payor Pricing.
• Analyze, configure, test, implement and maintain HealthRules Payor Pricing to support changes in contracts, products, legislation, policies, and procedures, ensuring timely maintenance and updates of configuration
• Test, implement and train on new HealthRules Payor PricingPricing and third party product releases, modules and updates.
• Assist in the development of test scenarios for changes and/or projects. Manage the timely resolution of open testing bugs and issues. Develop and monitor postproduction audit reports to ensure the intent of change and/or project requirements is being met.
• Develop and maintain configuration documentation and communicate changes, as appropriate.
• Work with Business Users, Technical team and QA to create detailed functional requirements that support and align to business requirements and testing scenarios.
• Research and respond to service requests in a prompt and timely manner and update or build configuration in HealthRules Payor Pricing as needed.
• Recommend and draft new and updated procedures to maximize the use of HealthRules Payor Pricing and other third-party products to improve efficiency.
• Inform leader and peers of changes that will impact Company’s Medicare business. Research and recommend methods to improve or implement necessary changes in a prompt and efficient manner.

Long Description

Experience/Skills:

• Minimum of 3 years of experience in payer operations, claim processing, and experience deploying HealthRules Payor Pricing software.
• Minimum of 3 years of hands-on configuration experience in HealthEdge's HealthRules software.
• Must possess working knowledge of Medicare operations, system development and testing.
• Expertise in using Microsoft Office; including Excel, Word, Access, Power Point, and Visio.
• Experience working within a matrix organization. Excellent oral and written communication skills and the ability to interface with all levels of customer organization
• Collaboration, leadership, organizational, writing, interpersonal and communication skills.

Preferred Requirement:

• Previous experience with CMS and Medicare Operations.
• Knowledge of or experience with ClaimXten, Axiom TranSend, and Axiom TransShuttle

Education qualification:

• Bachelor’s degree in business or health care preferred; demonstrated work experience may be considered in lieu of degree.