Dispute Repricing Specialist

Job Description: • Review provider dispute resolutions according to organizational guidelines. • Research and respond to provider participation and pricing inquiries, specifically related to network contracts and agreements. • Research identified issues; submit claim adjustment requests and determine the root cause of disputes. • Serve as subject matter expertise in evaluating and responding to provider participation and pricing inquiries. • Analyze post-paid healthcare claims as it relates to pricing needs. • Apply in-depth research to determine accuracy of PPO(s) use and pricing discounts applied. • Communicate externally and with internal departments as it relates to various cases under review. • Coordinate with other departments as necessary to facilitate resolution of claim related participation and pricing issues. • Reading and interpreting appeals, standard reference materials, etc. • Perform other duties as assigned. Requirements: • 2+ years of experience in healthcare, specifically with medical terminology, claim forms, and physician billing coding. • 1+ years of experience with provider disputes. • Demonstrated technical proficiency with Microsoft Office applications (Outlook, Excel, Teams, etc.). Benefits: • Affordable medical plan options • 401(k) plan (including matching company contributions) • Employee stock purchase plan • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Paid time off • Flexible work schedules • Family leave • Dependent care resources • Colleague assistance programs • Tuition assistance • Retiree medical access Apply tot his job