Burgess Source Configurator - Medicaid
About the position The Burgess Source Configurator is responsible for configuring and maintaining the Burgess Source payment integrity and claims pricing platform in support of Medicaid claims processing and reimbursement operations. This role ensures accurate implementation of pricing rules, regulatory requirements, and reimbursement methodologies to support compliant and efficient claims adjudication. The configurator translates Medicaid policies, CMS guidance, and payer reimbursement methodologies into system configurations and works closely with claims operations, compliance, and IT teams to ensure pricing accuracy, resolve discrepancies, and maintain payment integrity controls.
Responsibilities
- Platform Configuration & Policy Implementation Configure and maintain pricing rules, edits, and reimbursement logic within the Burgess Source platform
- Translate Medicaid policies, CMS regulations, and payer contract requirements into system configurations
- Implement and maintain custom fee schedules, provider reimbursement methodologies, and policy-driven pricing rules
- Ensure configuration changes are properly documented, version-controlled, and traceable Testing, Validation & Quality Assurance
- Develop and execute test plans for new configurations, policy updates, and system releases
- Perform regression testing to ensure pricing accuracy and system stability following updates
- Validate system outputs against expected Medicaid reimbursement methodologies and regulatory requirements Claims Pricing Analysis & Issue Resolution
- Investigate claims pricing discrepancies and conduct root cause analysis
- Troubleshoot configuration issues impacting Medicaid claims adjudication and payment integrity
- Partner with business, compliance, and IT teams to resolve pricing and reimbursement issues Data Management & System Integration
- Support ingestion and maintenance of Medicaid fee schedules, provider files, and reference data
- Ensure data accuracy and integrity within the pricing platform
- Assist with troubleshooting data integration and system interface issues between Burgess Source and claims processing systems
Requirements
- 5+ years of experience in healthcare payer operations, claims processing, or payment integrity
- Hands-on experience configuring Burgess Source or similar claims pricing/payment integrity platforms
- Strong knowledge of Medicaid reimbursement methodologies, CMS regulations, and claims adjudication workflows
- Experience supporting the configuration, testing, and implementation of claims pricing logic
- Proficiency with Microsoft Office tools, particularly Excel for data validation and analysis
- Strong communication skills and ability to work effectively within cross-functional teams
Nice-to-haves
- Experience supporting state Medicaid programs or Medicaid Managed Care Organizations (MCOs).
- Knowledge of Medicaid reimbursement models, such as: DRG APC Fee schedules Value-based reimbursement models
- Experience with payment integrity or claims editing platforms, such as: Burgess Source Cotiviti Optum Claims Editing Change Healthcare ClaimCheck
Benefits
- Medical / Dental / Vision Insurance – insurance premium assistance provided
- Additional Insurance (Life, Disability, etc.)
- Paid Time Off
- 401(k) Retirement Savings Plan & Health Savings Account
- Various training courses to promote continuous learning
- Corporate Wellness Program
Apply tot his job Apply To this Job