CERIS Repricing Quality Assurance Analyst I

CorVel Corporation; Fort Worth, Northern (TX, KY); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Medical and Pharmacy Insurance

Dental Insurance

Vision Insurance

401K and ROTH 401K

Paid Time Off

Job summary

CorVel Corporation is seeking a Repricing Quality Assurance Analyst I in Fort Worth, Texas. The role covers monitoring repricing audit data for accuracy and compliance while collaborating with internal teams to enhance operational effectiveness.

The ideal candidate will have strong knowledge in repricing claims processing and a minimum of 5 years in relevant fields. The position promotes a supportive culture and offers comprehensive employee benefits.

Qualifications

• 5+ years in medical/insurance repricing, claims processing, or auditing.
• 3+ years in quality assurance or equivalent combination of education and experience.
• Repricing or network contracting experience preferred.

Responsibilities

• Identify and resolve quality issues within repricing processes.
• Develop and implement QA policies and procedures.
• Monitor compliance with pricing guidelines and contractual requirements.
• Investigate repricing discrepancies and apply corrective actions.
• Prepare QA reports and documentation.

Skills

Repricing claims processing

Healthcare revenue cycle knowledge

Regulatory compliance knowledge

Microsoft Office proficiency

Analytical skills

Communication skills

Attention to detail

Teamwork

Education

High School Diploma

Associate's or Bachelor's degree preferred

Job description

CERIS Repricing Quality Assurance Analyst I

Job Category: CERIS

Requisition Number: CERIS011465

• Full-Time

Locations

Showing 1 location

TX - Fort Worth
5128 Apache Plume Rd
Suite 400
Fort Worth, TX 76109, USA

The Repricing Quality Assurance Analyst is responsible for reviewing, analyzing, and monitoring repricing audit data across multiple platforms to ensure accuracy, compliance, and efficiency. Works closely with internal teams to maintain contractual and organizational standards, enhance operational effectiveness, and improve client satisfaction.

This is a remote position.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES

• Identify and resolve quality issues within repricing processes
• Develop and implement QA policies and procedures
• Monitor compliance with pricing guidelines and contractual requirements
• Investigate repricing discrepancies and apply corrective actions
• Prepare QA reports and documentation
• Collaborate with stakeholders to align quality objectives
• Provide training and guidance on repricing standards
• Conduct risk assessments to mitigate potential errors
• Maintain confidentiality of client data, PHI, and PII
• Additional duties as assigned

KNOWLEDGE & SKILLS

• Strong understanding of repricing claims processing, and contractual rate application
• Knowledge of healthcare revenue cycle and reimbursement
• Knowledge of applicable regulations and pricing guidelines
• Proficiency in Microsoft Office and multi-platform systems
• Excellent analytical, problem-solving, and communication skills
• High attention to detail with the ability to work in fast-paced environments
• Ability to work independently and within a team environment

EDUCATION & EXPERIENCE

• 5+ years in medical/insurance repricing, claims processing, or auditing
• 3+ years in quality assurance or equivalent combination of education and experience
• Repricing or network contracting experience preferred
• High School Diploma or higher required; Associate's or Bachelor's degree preferred

PAY RANGE

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CERIS

CERiS, a division of CorVel Corporation, a certified Great Place to Work Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.