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Healthcare Claims Repricing Analyst

Employers Health Nexus
Irving, TX 75038
Hybrid work
Full-time

Location

Irving, TX 75038

Benefits
Pulled from the full job description

  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Prescription drug insurance
  • Vision insurance

Full job description

ROLE AND RESPONSIBILITIES:

This role will be responsible for claims administration, roster management, and appeal resolution within the Network Operations Department.

  • Maintain and review all inbound claims for network and pricing accuracy.
  • Implement Quality Assurance measures to ensure contract configuration accuracy.
  • Work directly with TPA’s and clients to research and resolve claims and services inquiries.
  • Work directly with vendor partners to determine the root cause of pricing inaccuracies and determine resolution.
  • Collaborate with Network Development to ensure new provider contract reimbursements are loaded accurately and in a timely fashion.
  • Work directly with vendor partners to load, update, and maintain provider rosters.
  • Work directly with vendor partners to manage annual fee schedule updates.
  • Analyze and identify trends in performance that offers continued efficiency within department.
  • Proactively analyze and identified trends in quality results that support our operational goal of continuous process improvement
  • Any other responsibilities assigned by his/her supervisor.

SKILLS AND COMPETENCIES:

  • Microsoft Office Suite and advanced MS Excel skills
  • Highly self-motivated and directed
  • Able to exercise independent judgment and take action on it
  • Strong analytical and critical thinking skills and the ability to report findings in a concise and accurate manner
  • Ability to effectively prioritize and execute tasks while under pressure
  • Work cooperatively with people at all levels with respect and demonstrate the ability to respond appropriately in a variety of complex situations;
  • Excellent verbal and written communication and presentation skills

COMPETENCIES:

  • Problem Solving/Analysis
  • Technical Capacity
  • Thoroughness
  • Time Management
  • Attention to Detail

POSITION TYPE AND EXPECTED HOURS OF WORK:

This is a full-time, salaried position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m., with occasional after-hours or weekend duties.

TRAVEL:

This position may require 10% travel from Dallas, Texas.

REQUIRED EDUCATION AND EXPERIENCE:

  • Understanding of claims processing systems
  • 2+ years of healthcare claims processing (PPO and Medicare/RBP)
  • Detailed understanding of PPO repricing, provider contract configuration and reimbursement experience
  • Familiarity with management of self-funded employer health plans
  • Experience in provider network development, including physician and hospital pricing metrics and methodologies
  • Strong Microsoft Excel Skills.

Job Type: Full-time

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Prescription drug insurance
  • Vision insurance

Schedule:

  • 8 hour shift
  • Monday to Friday

Work setting:

  • Hybrid work

Application Question(s):

  • Do you have detailed understanding of PPO repricing, provider contract configuration and reimbursement experience?
  • Do you have understanding of claims processing systems?
  • Are you familiar with management of self-funded employer health plans?
  • Do you have experience in provider network development, including physician and hospital pricing metrics and methodologies?

Experience:

  • healthcare claims processing (PPO and Medicare/RBP): 2 years (Required)

Work Location: Hybrid remote in Irving, TX 75038