Pricing Specialist

Overview

Scope of Responsibilities:   Responsible for monitoring and reporting of all network pricing items impacting company profitability while identifying opportunities to maximize profitability where appropriate. Partner with IT/Analytics to utilize maximum technological resources to create models/reporting to service internal and external partners. Assists with running internal and external reports.

Job Summary: Analyze and review claims data at both a client and book of business level and provide feedback on opportunities to improve performance. Utilize data analytics to provide efficiencies and cost savings. Assists ProAct Analytics department with requests for reports and data analysis from clients, management, and staff in an accurate, organized, and timely manner. Complete daily, monthly, quarterly, and ad-hoc standardized reporting requests.

Responsibilities

• Monitor and adjust client network pricing to ensure that client targets are met while maximizing ProAct performance.
• Analyze, develop, and present reporting on individual client performance to ensure contractual optimization.
• Submit pricing adjustments and ensure they were put in place correctly.
• Submit pricing for new clients prior to effective start date.
• Complete the daily dashboard for client’s performance for generics and specialty.
• Complete client performance reconciliations
• Responsible for preparing savings, disruption, copay modeling, and impact reports.
• Create metric models to assist upper management in financial decision making.
• Assist in day-to-day ad hoc reporting/data analytics requests as needed.
• Responsible for preparing savings, disruption, copay modeling, and impact reports.
• Collaborate with Finance to understand problems and define business requirements.
• Collaborate with various department managers to identify, develop, and maintain reporting needs.
• Responsible for preparing standard reports for clients, management and staff utilizing the ProAct suite of reporting tools which include Microstrategy and SSRS
• Automate reporting where possible to ensure department efficiency.
• Responsible for completing all mandatory and regulatory training programs.
• Perform other duties as assigned.

Qualifications

Job Skills Required:

• Exceptional attention to detail, written, interpersonal and communication skills.
• Must be able to effectively communicate internally and externally, via phone and through email.
• Strong PC skills including Microsoft Office, SQL, Powerbi, and Microstrategy
• Must be able to work independently.
• Strong analytical skills
• Through knowledge of financial systems and analysis

Educational Requirements:

• Minimum: high school diploma
• Preferred: associate degree or higher

Experience Preferred:

• Preferred: 1-year previous experience in a health benefits related field
• Must be proficient with prior experience using Excel.
• Must possess knowledge of security concepts applicable to this role and function.

Compensation:

$21.00-23.00 per hour.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education. 

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.