Pricing Specialist

Imagine360

1d•Remote

About The Position

Imagine360 is seeking a Pricing Specialist to join the team! This Pricing Specialist is responsible for maintaining new and current provider and PPO information in the claims software system. This position also ensures the accuracy of repricing and claim disputes and appeals information. Position Location: 100% remote

Requirements

High school diploma or GED.
1+ years in a Medical Field or Call Center.
Proficient typing and 10 key skills.
High level critical thinking skills.
Working knowledge of computers and software including but not limited to Microsoft Office products.
Experience and comfort in using multiple complex computer programs.
Demonstrated leadership, organizational, problem-solving, and analytical skills as well as detailed oriented.
Strong written, telephonic and oral communication skills.
Demonstrated ability to work independently, prioritize workloads, multi-task and manage priorities in order to meet deadlines.

Responsibilities

Validating and maintaining provider data from internal and external sources to maintain claims system functionality.
Maintaining accurate provider information.
Ensuring providers are affiliated to the appropriate PPO after repricing to ensure accurate payment for claims.
Contacting providers for necessary information and documents information appropriately.
Verifying effective and termination dates for providers with the PPO to ensure correct repricing.
Ensuring accurate PPO or contract information is current in claims processing system in order to ensure correct discount and payment of claims.
Proactively identifying the need to contact provider or PPO for additional or missing information as necessary.
Researching repricing appeals from PPOs and providers.
Working with PPO contacts to confirm contract discount rate and verification of claims submitted.
Relaying decision of PPO of payment to Claims Examiner for release of claim.
Acting as a role model in demonstrating the core values in customer service delivery.
Providing timely and thorough follow up with, internal and external customers.
Appropriately escalating difficult issues up the chain of command.
Serving on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction.
Recognizing and alerting appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
Performing self-quality monitoring in order to develop and execute plans to meet established goals.
Providing ongoing feedback to help optimize quality performance.
Collaborating with others and cross-departmentally to improve or streamline procedures.
Developing new or improving current internal processes to improve quality.

Benefits

Multiple Health plan options
Company paid employee premiums for disability and life insurance
Parental Leave Policy
20 days PTO to start
10 Paid Holidays
Tuition reimbursement
401k Company contribution
Company paid Short & Long term Disability plus Life Insurance
Professional development initiatives / continuous learning opportunities
Opportunities to participate in and support the company's diversity and inclusion initiatives