Configuration Pricing and Quality Analyst

March 15

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HealthAxis Group

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HealthAxis Group is a technology solutions provider specializing in healthcare administration. Their cloud-native platform, AxisCore™, streamlines health plan management through solutions like claims processing and benefit administration, designed to enhance operational efficiency. HealthAxis offers a suite of services including Business Process as a Service (BPaaS), consulting, and staff augmentation. The company's approach focuses on scalability, compliance, and tailored support, aiming to empower healthcare organizations to meet member needs effectively.

Claims Processing Software • Business Process Outsourcing (BPO) • Third Party Administrative Services • business process as a service (BPaaS) • Core Administrative Processing

201 - 500 employees

Founded 1965

⚕️ Healthcare Insurance

☁️ SaaS

💳 Fintech

📋 Description

• HealthAxis is a prominent provider of core administrative processing system (CAPS) technology... • Transforming the way healthcare is administered by providing innovative technology... • Seeking a highly skilled professional with expertise in system pricing configuration... • Develop, implement, and maintain pricing configuration models... • Configure pricing systems to ensure accurate reimbursement and compliance... • Collaborate with cross-functional teams to implement system changes... • Analyze and resolve pricing discrepancies... • Utilize Payer Compass to configure pricing systems... • Apply in-depth knowledge of Medicare, Medicaid, and Commercial payer systems... • Conduct thorough testing of pricing configurations to ensure accuracy... • Work closely with internal teams, including finance, operations, IT, and compliance... • Maintain detailed documentation on pricing configurations... • Assist in audit preparation and regulatory reporting...

🎯 Requirements

• 8 + years pricing configuration experience • Preferred 5+ years working with Payer Compass software • Knowledge of Health Care industry including medical terminology, claims processing guidelines, industry vernacular, code sets associated with system configuration and basic billing knowledge • Knowledge of managed care health insurance programs with an emphasis on CMS knowledge. Medicare Advantage experience is preferred • Knowledge of healthcare reimbursement models, including fee-for-service, bundled payments, and value-based care • Proven experience in quality assurance, testing, and configuration management in a healthcare payer environment. Advanced skills in MS Office products including Outlook, Word, Excel, MS teams and SharePoint • Experience with CMS regulations, pricing methodologies, audit processes and expectations • Intermediate to advanced experience using a relational database and Microsoft SQL Server Management Studio knowledge to retrieve and analyze data • Successfully navigate and master proprietary software programs • Extensive knowledge of CPT, HCPCS, and ICD-10 • Excellent problem-solving skills and attention to detail • Strong communication and interpersonal skills with the ability to collaborate effectively with cross-functional teams