• Serves as a knowledge expert and maintains up to date working knowledge of pricing guidelines in order to act as a resource for all pricing team members.
• Responsible for reviewing data in the review application and client claim processing system, and comparing with corresponding UB, medical record or other documentation.
• Responsible for reviewing all necessary documentation as necessary to determine appropriate reimbursement for a claim.
• Responsible for reviewing adjudication software systems claim and line items for determination of how to price a claim / line item.
• Possess ability to work at a computer for extended periods.
• Performs quality reviews on individual team members ensuring all claims are completed timely and per department standards.
• Identifies education needs within the department to facilitate pricing accuracy improvement.
• Works collaboratively with Assistant Director of Pricing to analyze and optimize processes to maintain acceptable productivity rates for each individual team member.
• Works collaboratively with Assistant Director in developing educational tools for new hire orientation and ongoing department education.
• Other duties as assigned.

• Associates degree preferred.
• Minimum of 5 years management experience
• Minimum of 5 years related work experience. Prior experience with claim adjudication systems, grouping and pricing software, and other claim adjudication and claim pricing systems. Ie; Facets, Cosmos, CAS, WebStrat, Encoder.
• Experience with pricing reject resolution
• Basic knowledge of medical terminology.
• Good knowledge of Microsoft Word, Excel and Outlook
• Intermediate mathematics aptitude
• Good communication skills
• Good organizational abilities
• Good comprehension capabilities
• Ability to prioritize multiple tasks
• Experience with UB/institutional claims
• Knowledge of Medicare and Medicaid billing & payment and coverage guidelines
• Strong experience in the analysis and processing of claims, quality assurance, CMS payment methodologies (i.e., DRGs, Cost Outliers)
• Must be able to work with minimal supervision
• Creative thinker with good skills at problem resolution specifically related to healthcare claim adjudication
• High speed internet (300 Mbps per person recommended) with secured WIFI.

• Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
• 401(k) with Employer Match - Join the team and we will invest in your future
• Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when youre not feeling well, to observe holidays.
• Wellness - We care about your well-being. From Commuter Benefits to FSAs weve got you covered.
• Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, were focused on your growth as a working professional.

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