Pricing & Provider Analyst

Team Overview: 

The Provider Experience team supports ZERO’s vision of healthcare simplified to $0 by supporting the providers in our network. The team is responsible for analyzing insurance pricing data, processing medical claims, supporting referrals to ZERO providers, and provider issue resolution. Provider Experience collaborates with all other teams within the company delivering the best experience possible to the members, clients and providers we serve. 

Job Summary:    

The Pricing &  Provider Analyst for Provider Experience will lead efforts to develop, implement and manage data-driven pricing strategies, comprehensive savings analyses, and advanced data management across pricing databases and tools to support sales and provider networks. This includes leveraging analytics to drive financial and operational efficiencies, and helping translate analyses and findings into actionable insights for internal teams to fully support ZERO’s mission to make healthcare more accessible and cost-effective. 

Key Responsibilities of Position:

• Claims Review Savings Analysis: 
• • Identify trends, including carrier data percentage distributions and their impact on overall pricing and identify low cost carriers.
  • Analyze trends with savings and provider pricing within category, provider, bundle level, geography and carrier.
  • Review Savings Analyses  prior to distribution to clients and review possible problems and concerns as reported by Sigma.
• Data & Analytics Management: 
• • Analyze pricing databases to interpret complex data sets to uncover pricing trends, insights and actionable information to support updates to provider fee schedules and pricing for savings reports.
• Pricing Tools and Sales Support 
• • Analyze and establish pricing sent to prospective providers
  • Work within our tools to establish standard pricing sent to prospective providers 
  • Review prospective providers pricing that falls below 30% savings 
  • Review Exhibit A documents prior to sending out for accuracy and uniformity
• Process Improvement & Strategy Development:
• •  Identify and implement best practices for pricing and analytics that streamline processes, enhance provider satisfaction, and reduce administrative burden. 
  • Drive initiatives to improve efficiency in pricing updates, fee reviews, and savings analyses. 
  • Contribute to strategic planning for the Provider Experience team by identifying opportunities to optimize pricing and enhance provider relationships. 
• Cross-Functional Collaboration: Partner with teams across the organization including Engineering,  Network Development, Provider, Member and Employer Experience teams to align pricing strategies with ZERO’s cost-savings goals. 

Qualifications:

• Minimum 5 years of relevant experience in the healthcare industry
• An understanding of healthcare services and procedures 
• Knowledge of CPT/HCPCS, DRG and UB Revenue coding
• Good understanding of claims processing and ideally bundled payments
• Strong analytical and problem-solving abilities, with a data-driven mindset
• Ability to work independently and collaboratively in a fast-paced environment
• Strong organizational, time management and interpersonal skills
• Excellent written and oral communication skills
• Proficiency in Mac computers,  analytic platforms, Microsoft Office and Google Suite
• Associate degree, Bachelor's Degree or equivalent experience
• Must be able to pass a criminal background check

What We Offer: 

• Competitive salary and performance-based bonuses
• Comprehensive health benefits package
• Flexible time off policy
• A supportive and dynamic team environment
• The opportunity to make a meaningful impact on the healthcare industry