Healthcare Pricing Configuration Consultant
Job Summary
As a full-time remote Healthcare Pricing Configuration Consultant, the successful candidate will design, configure, and optimize provider reimbursement solutions to support accurate claims adjudication and contract pricing for healthcare payer organizations.
Key responsibilities
- Configure and maintain provider contracts, fee schedules, and reimbursement methodologies within the NetworX Pricing platform
- Analyze business and contractual requirements, translating them into accurate pricing and reimbursement configurations
- Partner with cross-functional teams to implement, validate, and support pricing solutions while resolving related issues
Required qualifications
- Extensive experience with provider contract pricing and reimbursement configuration in healthcare payer organizations
- Strong experience with NetworX Pricer and NetworX Modeler
- Expertise in configuring FACETS claims adjudication and related business processes
- Strong SQL skills for data analysis, validation, and troubleshooting
- Deep knowledge of Commercial, Medicare, and Medicaid healthcare payer operations
Complete Job Description
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