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Provider Reimbursement Specialist

Productive Processing, Inc.
4.2 out of 5
Madison, WI


Madison, WI

Full job description

The Provider Reimbursement Specialist is responsible for configuring the provider pricing information in the claims processing system. The Provider Reimbursement Specialist facilitates the pricing of medical claims, utilizing provider contracts and schedules including Medicare, Medicaid, UCR and Network contracts. This position will also handle any inquiries from providers or our clients regarding pricing issues.

Essential Functions and Responsibilities

  • Monitor and manage the assigned pricing queues. This includes accurately pricing claims, document and completing all tasks within the required turnaround time.
  • Interface with client and/or medical providers, as appropriate, to gather information and problem solve. Facilitate and manage appeal resolution.
  • Work with the client on pricing related issues
  • Handle inquiries from providers regarding payment issues
  • Perform research internally and externally (via internet and/or outside agencies) to obtain supporting information to price claims.
  • Maintain strong knowledge of medical coding and contract rate reimbursement policies and procedures for pricing medical claims.

Additional Functions and Responsibilities

  • Assist in claims processing activities

Required Skills & Abilities

  • Education: High School Diploma/GED or equivalent.
  • Minimum 3 years healthcare related experience in a claims processing environment
  • Experience within different lines of health insurance industry including commercial, Medicare, and/or Medicaid
  • In depth knowledge of ICD-10, CPT, Revenue Codes, HCPCS coding, experience with all claim forms.
  • Excellent written and verbal communication skills
  • Ability to remain focused and productive in a work environment that includes repetitive tasks
  • Basic mathematic skills and good reading skills
  • Ability to work independently in a team environment, be adaptable and offer creativity in a continually changing environment.
  • Proficient in Microsoft Office suite.

Preferred Skills & Abilities

  • Provider pricing experience
  • Knowledge of medical claims coding and terminology
  • Familiarity with medical, dental, and/or hospital bills

Job Type: Full-time

Work setting:

  • Remote

Work Location: Remote