**Location:** Avera Health Plans **Worker Type:** Regular **Work Shift:** Day Shift (United States of America) **Pay Range:** _The pay range for this position is listed below. Actual pay rate dependent upon experience._ $60,840.00 - $91,520.00 **Position Highlights** **You Belong at Avera** **Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.** **A Brief Overview** The Payment Configuration Analyst is responsible for maintaining and updating diagnosis-related group (DRG) and ambulatory payment classification (APC) logic within the Optum EasyGroup system. This role ensures accurate claims adjudication, consistent application of reimbursement methodologies, and compliance with CMS and organizational policies. This position will collaborate closely with teams across Claims, IT, Provider Contracting, and Medical Economics to optimize system performance and support operational excellence in payment accuracy. **What you will do** + Configure and maintain DRG and APC grouping logic in Optum EasyGroup software to reflect CMS updates, contract-specific modifications, and organizational reimbursement policies. + Perform onsite testing and validation of DRG/APC logic changes to ensure accuracy and minimize claims payment errors. + Collaborate with internal teams (e.g., Claims, Configuration, IT) to support system updates tied to new payment methodologies, benefit changes, and contract implementations. + Monitor system behavior and conduct audits to identify configuration errors, trends in misgrouped claims, or payment discrepancies. + Interpret CMS regulatory updates and fee schedule releases and apply changes within the system. + Develop strategies to address or resolve error code processing from grouping software in compliance with Avera Health Plans policy, procedure, and contract objectives. + Participate in cross-functional meetings involving payment methodology enhancements, new service line implementations, or provider contract changes impacting payment rules. + Document configuration rules, decisions, and maintenance procedures to ensure transparency and knowledge continuity. + Respond to escalated issues related to grouping discrepancies or system behavior involving DRG/APC calculations. **Essential Qualifications** The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + 1-3 years Working with DRG/APC reimbursement methodologies in a health plan, hospital billing, or claims processing environment. + Solid understanding of CMS inpatient and outpatient payment systems, including IPPS, OPPS, and Medicare severity DRGs (MS-DRGs). + Strong attention to detail and ability to interpret technical documentation and payment methodologies. + Excellent analytical, troubleshooting, and communication skills. **Preferred Education, License/Certification, or Work Experience:** + Bachelor's in Health Information Management, Health Informatics, Healthcare Administration, or a related field. + Experience with Optum EasyGroup or similar grouping logic engines (e.g., 3M Grouper, TruCode, or Optum's CES). + Proficiency in Microsoft Excel and familiarity with data analysis tools or SQL. **Expectations and Standards** + Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community. + Promote Avera’s values of compassion, hospitality, and stewardship. + Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity. + Maintain confidentiality. + Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment. + Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable. **Benefits You Need & Then Some** Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future. + PTO available day 1 for eligible hires. + Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan + Up to 5% employer matching contribution for retirement + Career development guided by hands-on training and mentorship _Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to_ _talent@avera.org_ _._ At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward. The policy of Avera to provide opportunities for all qualified employees or applicants without regard to disability and to provide reasonable accommodations for all employees or applicants who may be disabled. Avera is committed to ensuring compliance in accordance with the Americans with Disability Act. For assistance, please contact HR Now at 605-504-4444. Additional Notices: For TTY, dial 711 Avera is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.