Ensure the documentation of technical standard business practices to support provider pricing configuration
Ensure the creation and maintenance of pricing Design Templates / structures to administer reimbursement requirements within Facets/NetworX based on CMS, Medicaid or Commercial payer requirements
Review provider contract terms and assess platform pricing capabilities to ensure administrability of documented terms
Identify, design, and implement internal process improvements by working with stakeholders to understand opportunities related to provider pricing functions
Lead large-scale cross-functional end-to-end Pricing Configuration projects and ensure participation from internal / external teams, adherence to deadlines and the completion of testing protocols
Participate in and manage root cause analysis and break/fix functions
Ensure technical staff maintain pricing knowledge by working with Configuration Analysts, Managers, Supervisors, IT, and Subject Matter Experts to support and promote accurate provider pricing
Generate claim reports that help scale and quantify rework associated with incorrect provider pricing installation
Set team direction, participate in the development of business strategy
Develop and manage business plans to achieve objectives
Influence senior leadership to adopt changes in process
Forecast and plan resource requirements
Review work performed by others; and suggest recommendations for improvement
Adapt departmental plans and priorities to address business and operational challenges
Authorize deviations from standards
Solve complex problems and develops innovative solutions
Provide explanations and information to others on the most complex issues
Prepare and present performance results in a timely manner
Perform other duties as assigned
Required Qualifications:
Previous management experience working with professional-level employees in a provider pricing environment
5+ years of Facets / NetworX Pricing configuration experience
5+ years multi-product reimbursement requirements: Medicare, Commercial and Medicaid
5+ years provider reimbursement for hospital, ancillary and professional providers
5+ years MS SQL experience and the ability to coach others on best practices in managing data extracts and reports
Dexian is a leading provider of staffing, IT, and workforce solutions with over 12,000 employees and 70 locations worldwide. As one of the largest IT staffing companies and the 2nd largest minority-owned staffing company in the U.S., Dexian was formed in 2023 through the merger of DISYS and Signature Consultants. Combining the best elements of its core companies, Dexian's platform connects talent, technology, and organizations to produce game-changing results that help everyone achieve their ambitions and goals.
Dexian's brands include Dexian DISYS, Dexian Signature Consultants, Dexian Government Solutions, Dexian Talent Development and Dexian IT Solutions. Visit https://dexian.com/ to learn more.
Dexian is an Equal Opportunity Employer that recruits and hires qualified candidates without regard to race, religion, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.