ADDSOURCE
ADDSOURCE

Healthcare Price Transparency SME

Philadelphia, PA, US • Posted 19 hours ago • Updated 4 hours ago
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Job Details

Skills

  • Data Transformation
  • Facets
  • Amisys
  • Data Validation
  • Data Mapping
  • Data Reconciliation
  • Transparency in Coverage (TiC)
  • In-Network Rate Machine Readable Files (MRFs)
  • Provider Contracting
  • Fee Schedule Analysis
  • Reimbursement Methodologies
  • Negotiated-Rate Calculations
  • Technical Requirements Documents (TRDs)
  • Data Gap Analysis
  • Exception Handling
  • Inter-Departmental Collaboration
  • Healthcare Reimbursement
  • Technical-Business Liaison
  • US Healthcare Payer Domain
  • Healthcare Pricing
  • Price Transparency
  • HealthRules Payor (HRP)
  • DRG Reimbursement
  • APC Reimbursement
  • Per Diem Reimbursement
  • Case Rate Reimbursement
  • Capitation
  • Bundled Payments
  • Fixed Rates
  • Medicare Percentage Pricing
  • Business Requirements Document (BRD) Creation

Summary

Healthcare Price Transparency SME

Location: Remote

Role Summary:
Seeking a Healthcare Price Transparency SME with expertise in provider contracting, reimbursement methodologies, and MRF (Machine Readable File) generation. The role involves translating provider contracts, pricing data, and regulatory requirements into detailed technical requirements and business rules for engineering teams.

Key Responsibilities

  • Lead requirements definition for Transparency in Coverage (TiC) and In-Network Rate MRFs.
  • Analyze provider contracts, fee schedules, and reimbursement methodologies.
  • Convert contract terms into negotiated-rate calculations and reporting rules.
  • Develop and maintain Technical Requirements Documents (TRDs) covering data mappings, transformations, validations, calculations, and MRF output requirements.
  • Identify data gaps, dependencies, exceptions, and reconciliation requirements.
  • Partner with business, contracting, data, product, and engineering teams to support MRF implementation.
  • Serve as the bridge between healthcare reimbursement concepts and technical development.

Required Experience

  • 7+ years in US Healthcare Payer, Provider Contracting, Reimbursement, Healthcare Pricing, or Price Transparency.
  • Experience with FACETS, HealthRules Payor (HRP), Amisys, or similar payer platforms.
  • Strong understanding of reimbursement models such as Fee Schedule, Medicare %, DRG, APC, Per Diem, Case Rate, Capitation, Bundled Payments, and Fixed Rates.
  • Proven ability to translate complex healthcare contracts into clear technical and business requirements.

Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
  • Dice Id: 91122967
  • Position Id: 2026-4730
  • Posted 19 hours ago

Company Info

About ADDSOURCE

AddSource is a premier staffing and workforce solutions partner headquartered  in  Delaware,  USA,  with  operations  in  Alberta,  Canada  under  the  brand  name AddSource.

We  specialize  in  connecting  top-tier  talent  with  leading organizations across diverse industry sectors.

With  a  strong  commitment  to  excellence,  our  mission  is  to deliver innovative, customized staffing solutions that empower clients  to  achieve  their  goals  while  helping  candidates advance their careers.

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