Pricing and Reimbursement Analyst

ALTA IT Services, LLC; Dayton (OH); Remote; USD 75,000 - 95,000; Full time

Job summary

ALTA IT Services, LLC is seeking a Pricing and Reimbursement Analyst for an 8-month remote contract in Dayton, Ohio. The role requires in-depth knowledge of Medicaid contracts and the ability to analyze complex claims processes. Successful candidates will possess strong communication skills and demonstrate a capacity for independent problem-solving.

Benefits

Health and welfare benefits

401(k) plan participation

Qualifications

• Background in Medicaid fee service provider contracts.
• Experience in researching state Medicaid requirements.
• Ability to work independently in a fast-paced environment.

Responsibilities

• Research and develop configuration requirements for Medicaid provider contracts.
• Define payment terms and transform them into code-level agreement requirements.
• Facilitate discussions among diverse stakeholders.

Skills

End-to-end claims lifecycle knowledge

Provider network contracting

Regulatory compliance knowledge

Strong communication skills

Problem-solving ability

Job description

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Job Title: Pricing and Reimbursement Analyst

Location: Dayton, Ohio



Type: Contract

Compensation:

Contractor Work Model: Remote

Title: Pricing and Reimbursement Analyst

ALTA is supporting an 8-month contract opportunity working 100% remote. 2 roles are open.



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 arelooking 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.

For immediate consideration please contract Patrick Jackson at [e-mail]





System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.



System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.



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Ref: #860-IT Cincinnati

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Contract

Job function

• Job function

  Information Technology

• Industries

  Staffing and Recruiting

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