Medical Claims Repricing Specialist

AltaStaff is a staffing agency currently looking for a Claims Repricing Specialist to work with our Managed Care Client!

Location : Fully remote

Pay Rate : $19.00 - $20.00 hourly

Schedule : Monday-Friday, 8am-4 : 30pm

The Claims Repricing Specialist is responsible for reviewing medical claims selected for payment integrity audits and ensuring they are priced accurately based on the insurer's policies, contracts, and reimbursement schedules. They will analyze and submit claims to be adjusted as necessary to meet pricing guidelines and industry standards, ensuring the claims process is efficient, accurate, and compliant.

Job Responsibilities (but not limited to) :

• Utilize claims processing systems to reprice claims and ensure data integrity.
• Reprice medical claims based on contracted rates, including Medicare, Medicaid, PPO, HMO, and other networks.
• Apply the appropriate pricing, contractual rates, and reimbursement methodologies.
• Ensure that all pricing changes are well-documented and communicated clearly.
• Review medical claims for accuracy in accordance with insurance policy guidelines.
• Ensure that claims are processed correctly in terms of eligibility, coverage, and benefits.
• Collaborate with other departments (e.g., customer service, claims processing) to resolve complex claim processing issues.
• Investigate and resolve claims-related issues such as incorrect pricing, discrepancies between billed charges and contracted rates, and payment errors.
• Provide support in resolving claim disputes.

Required Education / Experience / Licensure :

AltaStaff is an Equal Employment Opportunity Employer. We provide equal employment opportunities to all qualified applicants for employment without regard to age, race, color, creed, religion, sex, marital status, national origin, ancestry, citizenship, disability, veteran status, sexual orientation, or any other protected status, in accordance with applicable federal, state, and local laws.

INDLP

Salary : $19 - $20