Medicaid Pricer Regulatory Analyst
Core
Entry-level analyst supporting senior teams in Medicaid reimbursement research, pricing logic updates, and data validation for healthcare payment systems.
Role type
Entry-level regulatory pricer analyst
Builds
Medicaid reimbursement pricing logic and configuration
Domain
US Healthcare Payer / Medicaid Reimbursement
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
Medicaid regulations research, data entry, Excel (formulas/lookups), claims adjudication process, claim coding, payer reimbursement policies, state/federal regulations, MS SQL Server Studio (plus)
Preferred skills
Certified coder (CCS/CCS-P/CPC), RHIA/RHIT, RN/LPN with coding knowledge
Responsibilities
Perform basic research on Medicaid regulations and fee schedules, summarize regulatory findings, maintain pricing logic and configuration via data entry, draft procedural documentation and SOPs, conduct data comparisons and validation using Excel, execute system test cases and document results, escalate pricing discrepancies to senior analysts
Seniority
Entry-level, foundational IC