CERIS Repricing Quality Assurance Analyst Team Lead

Ultipro; Fort Worth (TX); Remote; USD 90,000 - 130,000; Full time

Benefits offered by this job

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

paid time off

Job summary

CERIS, a division of CorVel, seeks a Repricing Quality Assurance Analyst Team Lead to review, analyze, and monitor repricing audit data across platforms, ensuring accuracy, compliance, and client satisfaction. Works closely with internal teams to improve operational effectiveness.

This remote position supports the organization from Fort Worth, TX, with opportunities to develop QA policies, train staff, and lead cross-functional initiatives while safeguarding PHI/PII data.

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.
• High School Diploma or higher required; Associate's or Bachelor's degree 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
• 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

Skills

Repricing processing

Healthcare revenue cycle

Regulations knowledge

MS Office

Analytical thinking

Communication skills

Detail-oriented

Independent & team work

Education

High School Diploma

Bachelor's or Associate preferred

Tools

Multi-platform systems

Job description

CERIS Repricing Quality Assurance Analyst Team Lead

Job Category: CERIS

Requisition Number: CERIS011840

• Full-Time

Locations

Showing 1 location

Fort Worth, TX 76109, USA

Description

The Repricing Quality Assurance Analyst Team Lead 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
• paid time off

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

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.