Claims Repricer

Operations

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.

This role prices professional, ancillary, and institutional claims for In Network, Out of Network and leased / rental network provider claims. Pricing is applied to incoming claims including adjustments, out of network, custom rates and schedule / contract % provider type contracts. This position ensures timely and accurately pricing of all claim types including adjustments, QA, Performance Guarantees and / MTM audits, email inquiries. Research complex requests to verify original claim pricing. Interpret and apply contract terms to claims / adjustments and high dollar claims. Collaborates with Provider Relations team to identify / locate fee tables and complex contract requirements. Works independently utilizing system resources and pricing tools.

2 years' related experience, claim processing, provider billing or familiarity with provider contracting

Some college a plus

Excellent mathematical skills, demonstrated proficiency in math

Strong computer proficiency with Microsoft Office including Excel

Excellent critical thinking and problem-solving skills

Excellent verbal and written communication skills

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.