Burgess Source Configurator - Medicaid (Remote)

Burgess Source Configurator - Medicaid

Location: Remote

About Us:

Known for “Delighting the Client” through performance, innovation, and an employee-centric culture, S2Tech is a fast-growing IT consulting company serving clients in over a quarter of the United States. We are widely recognized as a leading provider of both technical and business services in support of Health and Human Services-related projects. 

Why S2Tech?:

• Stable, privately-owned company with a strong reputation for building long-term client relationships through the delivery of consistent value-based service
• 25+ years providing IT and Business services to private customers and government programs throughout the United States
• Expansive client portfolio and active projects – employees benefit from innovative project exposure and in-house skill development training/courses  
• Corporate culture that emphasizes the importance of family and promotes a healthy work-life balance
• Offer competitive pay and a range of benefits, including:
• Medical / Dental / Vision Insurance – insurance premium assistance provided
• Additional Insurance (Life, Disability, etc.)
• Paid Time Off
• 401(k) Retirement Savings Plan & Health Savings Account
• Various training courses to promote continuous learning
• Corporate Wellness Program
• Be part of a company that gives back through its non-profit organization, Fortune Fund, which was launched in 2001. The goal of the Fortune Fund is to close the rural/urban divide by ensuring children in rural communities in India and the United States understand the importance of education & are aware of professional career opportunities, allowing them to link their professional & educational goals

Job Overview:

The Burgess Source Configurator is responsible for configuring and maintaining the Burgess Source payment integrity and claims pricing platform in support of Medicaid claims processing and reimbursement operations. This role ensures accurate implementation of pricing rules, regulatory requirements, and reimbursement methodologies to support compliant and efficient claims adjudication. The configurator translates Medicaid policies, CMS guidance, and payer reimbursement methodologies into system configurations and works closely with claims operations, compliance, and IT teams to ensure pricing accuracy, resolve discrepancies, and maintain payment integrity controls.

Responsibilities:

Platform Configuration & Policy Implementation

• Configure and maintain pricing rules, edits, and reimbursement logic within the Burgess Source platform
• Translate Medicaid policies, CMS regulations, and payer contract requirements into system configurations
• Implement and maintain custom fee schedules, provider reimbursement methodologies, and policy-driven pricing rules
• Ensure configuration changes are properly documented, version-controlled, and traceable

Testing, Validation & Quality Assurance

• Develop and execute test plans for new configurations, policy updates, and system releases
• Perform regression testing to ensure pricing accuracy and system stability following updates
• Validate system outputs against expected Medicaid reimbursement methodologies and regulatory requirements

Claims Pricing Analysis & Issue Resolution

• Investigate claims pricing discrepancies and conduct root cause analysis
• Troubleshoot configuration issues impacting Medicaid claims adjudication and payment integrity
• Partner with business, compliance, and IT teams to resolve pricing and reimbursement issues

Data Management & System Integration

• Support ingestion and maintenance of Medicaid fee schedules, provider files, and reference data
• Ensure data accuracy and integrity within the pricing platform
• Assist with troubleshooting data integration and system interface issues between Burgess Source and claims processing systems

Required Qualifications:

• 5+ years of experience in healthcare payer operations, claims processing, or payment integrity
• Hands-on experience configuring Burgess Source or similar claims pricing/payment integrity platforms
• Strong knowledge of Medicaid reimbursement methodologies, CMS regulations, and claims adjudication workflows
• Experience supporting configuration, testing, and implementation of claims pricing logic
• Proficiency with Microsoft Office tools, particularly Excel for data validation and analysis
• Strong communication skills and ability to work effectively within cross-functional teams

Preferred Qualifications:

• Experience supporting state Medicaid programs or Medicaid Managed Care Organizations (MCOs).
• Knowledge of Medicaid reimbursement models such as:
• DRG
• APC
• Fee schedules
• Value-based reimbursement models
• Experience with payment integrity or claims editing platforms, such as:
• Burgess Source
• Cotiviti
• Optum Claims Editing
• Change Healthcare ClaimCheck

S2Tech is committed to hiring and retaining a diverse workforce. We are an equal opportunity employer making decisions without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected class.