Repricing Associate (Temporary)

<h3>Accountabilities</h3><li>
<strong>Medical billing and data entry:</strong>Enter billing information and Medicare reporting data accurately while verifying ICD-10 and CPT-4 codes to support appropriate medical bill repricing.</li><li>
<strong>Regulatory compliance:</strong>Research and respond to inquiries within established turnaround times, ensuring compliance with applicable state laws and Medicare requirements.</li><li>
<strong>EDI claims processing:</strong>Investigate electronic data interchange (EDI) claim rejections, resolve processing issues, and apply manual repricing when necessary.</li><li>
<strong>Reconsiderations and appeals:</strong>Process and administer billing reconsiderations and appeals, coordinating with vendors and provider networks to support timely and accurate resolutions.</li><li>
<strong>Provider payment investigations:</strong>Research returned provider checks, investigate reimbursement inquiries, and process requests related to payment discrepancies.</li><li>
<strong>Reporting and documentation:</strong>Prepare comprehensive reports, maintain accurate records, and track inquiries and assigned tasks with minimal supervision.</li><li>
<strong>Vendor and network coordination:</strong>Participate in quarterly oversight meetings with preferred provider organization (PPO) networks and vendors to support effective collaboration and service quality.</li><li>
<strong>Cross-functional support:</strong>Cross-train on provider network responsibilities within the department and assist with additional operational duties as business needs evolve.</li><li>
<strong>Workflow and workload management:</strong>Prioritize assignments, navigate multiple systems simultaneously, and consistently meet deadlines and service standards.</li><li>
<strong>Customer service:</strong>Communicate professionally with internal and external stakeholders to resolve questions, clarify billing issues, and maintain positive working relationships.</li><h2>Requirements</h2><li>
<strong>Medical billing experience:</strong>Previous experience working in a medical billing environment is required.</li><li>
<strong>Education:</strong>A college degree or college-level education is preferred.</li><li>
<strong>Medical coding knowledge:</strong>A thorough understanding of billing and coding procedures, including familiarity with ICD-10 and CPT-4 codes, and a solid understanding of medical terminology.</li><li>
<strong>Medicare knowledge:</strong>Familiarity with Medicare and Centers for Medicare &amp; Medicaid Services (CMS) requirements is necessary.</li><li>
<strong>Coding certifications:</strong>Relevant medical coding accreditations are an advantage.</li><li>
<strong>Regulatory awareness:</strong>Ability to apply state-specific requirements, compliance standards, and turnaround time expectations to medical bill repricing activities.</li><li>
<strong>Technical proficiency:</strong>Strong computer skills and the ability to navigate multiple software applications and screens efficiently.</li><li>
<strong>Microsoft Office and collaboration tools:</strong>Proficiency with Microsoft Word, Excel, Outlook, Teams, Slack, Zoom, and internet-based applications.</li><li>
<strong>Analytical and reporting skills:</strong>Ability to investigate billing and reimbursement discrepancies, prepare detailed reports, and manage assigned tasks with minimal guidance.</li><li>
<strong>Communication skills:</strong>Excellent written and verbal communication skills, with the ability to interact professionally with providers, vendors, and internal colleagues.</li><li>
<strong>Attention to detail:</strong>Strong organizational skills and a commitment to accurate data entry, coding verification, documentation, and claims processing.</li><li>
<strong>Time management:</strong>Ability to multitask, prioritize competing assignments, and meet deadlines in a fast-paced environment.</li><li>
<strong>Independent and collaborative working style:</strong>Comfortable working autonomously while contributing effectively to a virtual team.</li><li>
<strong>Adaptability:</strong>A flexible, self-motivated approach and a willingness to embrace changing priorities, learn new processes, and cross-train on departmental responsibilities.</li><li>
<strong>Remote work readiness:</strong>Reliable internet access and the ability to work effectively in a fully remote environment.</li><li>
<strong>Customer service orientation:</strong>Strong service skills and a proactive approach to resolving inquiries and addressing stakeholder concerns.</li><h2>Benefits</h2><li>
<strong>Competitive hourly pay:</strong>$24–$29 per hour, depending on qualifications, geographic location, and other applicable factors.</li><li>
<strong>Fully remote work:</strong>Work from anywhere in the United States.</li><li>
<strong>Full-time temporary opportunity:</strong>Expected duration through Q2 2027.</li><li>
<strong>Professional experience:</strong>Gain hands-on experience in medical bill repricing, workers' compensation claims operations, Medicare reporting, and reimbursement processes.</li><li>
<strong>Cross-training opportunities:</strong>Develop broader knowledge of provider network operations and related departmental responsibilities.</li><li>
<strong>Collaborative virtual environment:</strong>Work with internal teams, external vendors, and healthcare provider networks.</li><li>
<strong>Skill development:</strong>Strengthen your expertise in medical coding verification, regulatory compliance, claims reconsiderations, and billing issue resolution.</li>