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Re-Pricing Claims Specialist

Position Code: 368

Department:  Cost Management
Location: Little Rock, Arkansas
Immediate Supervisor:  Lisa Clay
Status: Non-Exempt
Posted: January 31 2018

Essential Functions of Job:

• Re-Price medical claims using PPO Network’s on-line systems/tools • Resolve re-pricing disputes from Providers/Members • Re-Price claims based off client’s contract terms • Research medical claims, operational and customer service issues and make recommendations for resolution • Maintain an adequate daily production Pricing rate with acceptable defects as determined by Supervisor • Monitor all reports, emails, and call tracks routed to the Cost Management team • Monitor time service on claims sent via EDI to pricing vendors • Monitor and analyze, as needed, key indicators within the Pricing process • Coordinate the timely release (DOL) of all claims in the Pricing inventory • Resolve issues with claims that are edit/kicked out of the standard process • Ability to re-key claims in PPO network re-pricing tools • Route claims to other departments with clear and precise notes • Generate reports of job duties and production results to management team • Be able to handle both PPO re-pricing claims or the Edge re-pricing claims • Perform other duties as assigned • Ability to report to the office

Qualifications:

• College degree preferred, experience considered in lieu of degree • Effective organizational and prioritization skills • Excellent oral and written communication skills • Basic knowledge of Microsoft Office software applications (Word, Excel, Outlook, Access) • Ability to work in a fast paced multi-tasking environment • Strong interpersonal skills with the ability to function as a positive team member • Ability to calculate discounts, proportions, and percentages and apply basic algebraic concepts • Ability to read, analyze and interpret common clinical documents, financial reports, and legal documents • Ability to communicate and work with 3rd party business partners • 2-5 years related experience in the business field, clinical vendor management, financial and/or managed care preferred

 

The Company considers applicants without regard to race, color, national origin, sex, religion, mental or physical disability, marital status, age 40 years and over, sexual orientation or gender identity, veteran's status, or other characteristic protected by applicable law.

Applications for this vacancy will be received for 3 working days after the Posted date from Employees of HealthSCOPE Benefits with more than one year of service.

Applications for this vacancy will be received for 10 working days after the Posted date from External Applicants.

 

 

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