Pricing and Reimbursement Analyst

Job Title: Pricing and Reimbursement Analyst
Type: Contract
Contractor Work Model: Remote

ALTA is supporting an 8-month contract opportunity working 100% remote.

ALTA IT Services is a wholly owned subsidiary of System One, a leading provider of specialized workforce solutions and integrated services. ALTA is an established leader in IT Staffing and Services, for both government and commercial enterprises across the United States, specializing in Program & Project Management, Application Development, Cybersecurity, Data & Advanced Analytics, and Agile Transformation Services.

Position Overview:
We are seeking a highly analytical and detail-oriented Medicaid Configuration Analyst with specialized expertise in Facets/NetworXPricer. This role is crucial for ensuring our systems accurately reflect the complex payment methodologies associated with State Medicaid fee-for-service provider contracts.
The ideal candidate will possess a strong background in researching and interpreting State Medicaid documentation to develop precise configuration requirements. This involves a deep dive into State Medicaid fee schedules, Administrative Codes, State Plan documents, provider manuals, and other relevant materials to understand how State Medicaid agencies reimburse their providers. The core function of this role is to translate these intricate payment rules into detailed, code-level agreement requirements for configuration within the Facets/NetworXPricer systems.
Key Responsibilities:

• Conduct in-depth research and analysis of State Medicaid fee-for-service (FFS) provider contracts, fee schedules, Administrative Codes, State Plan Amendments (SPAs), provider manuals, and other official state publications.
• Interpret complex state-specific Medicaid reimbursement methodologies for various provider types and services.
• Translate researched payment rules and contract terms into precise, actionable, and code-level configuration requirements for Facets and NetworXPricer agreements. This includes, but is not limited to, defining requirements for:
  • Procedure codes (e.g., CPT, HCPCS)
  • Revenue codes
  • Diagnosis Related Group (DRG) codes
  • Place of Service (POS) codes
  • Modifiers
  • Billing and coding guidelines
  • Service limits and authorizations
  • Other critical data elements impacting claims adjudication and pricing.
• Develop and maintain comprehensive documentation of all researched requirements and corresponding configuration specifications.
• Collaborate closely with technical configuration teams, claims operations, and provider network management to ensure accurate implementation and testing of new or updated agreement configurations.
• Serve as a subject matter expert on State Medicaid FFS reimbursement policies and their impact on system configuration.
• Analyze and resolve configuration-related issues, discrepancies, and inquiries from internal and external stakeholders.
• Stay current with evolving State and Federal Medicaid regulations and their potential impact on system configurations.
• Participate in audits and reviews of system configurations to ensure ongoing accuracy and compliance.

Required Qualifications:

• Bachelor's degree in Healthcare Administration, Information Systems, Business, or a related field, or equivalent work experience.
• Proven experience (typically 3+ years) in researching and interpreting State Medicaid fee-for-service reimbursement methodologies and provider contract language.
• Demonstrable experience in defining configuration requirements for healthcare payer systems, specifically with Facets and/or NetworXPricer for provider agreements and pricing.
• Strong understanding of healthcare coding systems (CPT, HCPCS, ICD-10, DRG, Revenue Codes, POS codes).
• Familiarity with reading and interpreting State Medicaid Administrative Code, State Plan documents, fee schedules, and provider manuals.
• Excellent analytical, problem-solving, and critical-thinking skills with a meticulous attention to detail.
• Ability to translate complex regulatory and contractual language into clear and concise technical requirements.
• Strong written and verbal communication skills, with the ability to explain complex information to both technical and non-technical audiences.
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).

Preferred Qualifications:

• Direct hands-on configuration experience in Facets and/or NetworXPricer.
• Experience working directly with a State Medicaid agency or a Managed Care Organization (MCO) focused on Medicaid.
• Knowledge of SQL or other data analysis tools for research and validation purposes.
• Experience with Agile or other project management methodologies.

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Ref: #860-IT Cincinnati