Claims Repricer
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
This role prices professional, ancillary, and institutional claims for In Network, Out of Network and leased/rental network provider claims. Pricing is applied to incoming claims including adjustments, out of network, custom rates and schedule/contract % provider type contracts. This position ensures timely and accurately pricing of all claim types including adjustments, QA, Performance Guarantees and/MTM audits, email inquiries. Research complex requests to verify original claim pricing. Interpret and apply contract terms to claims/adjustments and high dollar claims. Collaborates with Provider Relations team to identify/locate fee tables and complex contract requirements. Works independently utilizing system resources and pricing tools.
· 2 years' related experience, claim processing, provider billing or familiarity with provider contracting
· Some college a plus
· Excellent mathematical skills, demonstrated proficiency in math
· Strong computer proficiency with Microsoft Office including excel
· Excellent critical thinking and problem-solving skills
· Excellent verbal and written communication skills
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Inclusion and Belonging
At AmeriHealth, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At AmeriHealth, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
AmeriHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.