Pricing Research Analyst

at  Sagility

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

JOB DESCRIPTION:

We are currently hiring a talented Pricing Research Analyst/Consultant to research, understand and then create pricing methodologies to be loaded into propriety claims audit software for the purpose of accurately pricing healthcare claims. Working with the Information Technology group, the Pricing Research Analyst/Consultant will serve as the direct point of contact for research and implementation of multiple State Medicaid and Medicare (CMS) pricing methodologies primarily focused on institutional (hospital) inpatient and outpatient claims. This role is paramount to company success ? an intrinsic curious, self-motivated, persevering, goal-oriented mindset is a must.

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.

EDUCATION

• High School Degree or GED required.
• BA/BS in Business Administration or related field a strong plus, experience will be considered to offset educational requirements.
• Certified Inpatient Coder (CIC) a plus
  Salary: $130,000

• 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