Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you’ll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
Huron is looking for a highly skilled NetworX Configuration SME to oversee the configuration, maintenance, and optimization of provider reimbursement methodologies within the NetworX Pricer platform. This expert will ensure that provider contracts and pricing rules are accurately interpreted and reflected in our claims payment environment.
Key Responsibilities
- Configure and optimize provider pricing rules, fee schedules, and reimbursement logic using NetworX Pricer.
- Analyze contract terms and translate them into systematic pricing configuration requirements.
- Validate pricing outcomes by performing test adjudication and reconciling variances.
- Partner with Provider Contracting, Claims, Finance, and IT teams to support new contract implementations and pricing updates.
- Monitor and troubleshoot pricing-related claims issues; lead root-cause investigations and recommend corrective actions.
- Ensure compliance with regulatory requirements, CMS pricing standards, and organizational policies.
- Maintain configuration documentation, version controls, and process maps.
Qualifications
- 4–7 years of hands-on NetworX Pricer configuration experience in a health plan or TPA environment.
- Expertise in provider pricing methodologies such as RBRVS, APC/DRG, custom fee schedules, and value-based reimbursement models.
- Strong knowledge of claims adjudication and provider contracting workflows.
- Ability to analyze complex pricing rules and convert them into scalable configuration logic.
- Excellent communication skills and attention to detail.
Position Level
Senior Associate
Country
United States of America