Pricing And Reimbursement Analyst

Description:

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.



Here is what we are looking for in a Pricing and Reimbursement Analyst:



Someone with a background in researching and developing the configuration requirements for Facets/NetworXPricer agreements, associated with Medicaid fee for service provider contracts. This means researching State Medicaid fee schedule requirements, Administrative Code and State Plan documents, State provider manuals, and other materials to be able to define how the State Medicaid agencies pay their providers and turning that into detailed code-level agreement requirements (procedure code, revenue code, DRG code, place of service code, etc.) to be configured into the system.
 

• Extensive knowledge of end-to-end claims lifecycle, from intake and encounter submission to adjudication routines and reimbursement.


• Hands-on experience with provider network contracting, including in-depth knowledge of reimbursement methodologies, including fee-for-service, DRG, per diem, capitation and value-based payment models.


• Familiarity with regulatory requirements across Medicare and Medicaid line of business – especially state-specific Medicaid rules & regulations.


• Experience with interpreting contract terms and amendments, including scope of services, rate structures, and regulatory compliance language.


• Knowledge of provider types and market dynamics, including hospitals, physicians, ancillary services, behavioral health, LTSS and others.


• Ability to work independently in a fast-paced environment, consistently identifying and implementing solutions to complex problems with no established protocols.


• Demonstrate strong communication skills to lead and facilitate cross-functional group discussions, ensuring alignment among diverse stakeholders as well as providing clear guidance and subject matter expertise to support collaborative problem-solving and decision-making.