Configuration Analyst

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September 16

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Sidecar Health

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Healthcare Insurance

Sidecar Health is a health insurance company that provides comprehensive major medical insurance with upfront pricing and no network restrictions or referral requirements. Their goal is to put employees in control of their healthcare by giving them a clear budget for care and allowing them to choose any doctor without surprise costs. They emphasize access to prescriptions without limitations and protection for unplanned care. Sidecar Health also offers transparent pricing and the option for members to save money if they find providers who charge less than their plan pays. Their offerings include individualized access plans and employer plans, ensuring members always have a choice of qualified doctors.

201 - 500 employees

Founded 2018

⚕️ Healthcare Insurance

📋 Description

• Coordinate and maintain all prospective payment system (PPS) configuration and/or external system pricer/grouper upgrades • Troubleshoot coding/grouping issues to determine appropriate assignment of DRG/APC • Serve as subject matter expert related to CMS pricing rules and methodologies (MS-DRG, CMG, ASC PPS, IPF PPS, IRF PPS, Professional claims) • Partner with training and documentation teams to build training, policy and procedure documentation related to external pricers/groupers and exception handling • Perform root cause analysis on claim and system issues • Partner with actuarial team on internal pricing methodology and updates • Support claims production teams with process questions and specific claim investigations • Implement and maintain accurate and timely critical information on claims databases • Remain current on CMS pricing rules, regulations, coding updates, changes, and issues • Interpret state and/or federal benefits, contracts, and business requirements and convert these terms to configuration parameters • Code, update, and maintain provider contracts, fee schedules, and various system tables through the user interface and PPS systems

🎯 Requirements

• 3+ years of experience with PPS coding, DRG Grouping & APC Payment methodology • Bachelor’s degree • Strong analytical skills with the ability to interpret complex data • Experience working industry standard groupers (3M, Optum, etc) • Knowledge of healthcare benefits, contracts, and fee schedules • Excellent communication and interpersonal skills • Ability to work independently and as part of a team in a fast-paced environment

🏖️ Benefits

• Competitive salary, bonus opportunity, and equity package • Comprehensive Medical, Dental, and Vision benefits • A 401k retirement plan • Paid vacation and company holidays • Opportunity to make an impact at a rapidly growing mission-driven company transforming healthcare in the U.S.