Provider Pricing Specialist

Health Plans, Inc.; United States; On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Medical, Dental and Vision Coverage

Prescription Drug Coverage

Flexible Spending Account & Health SAV

401(k) and Profit-Sharing Plan

Quarterly Bonuses

Generous Paid-Time Off

Education Assistance & Professional1

Job summary

Health Plans, Inc. is seeking a Provider Pricing Specialist to manage provider databases, support claims pricing questions, and assist with provider/member appeals. You will help researchers settle pricing inquiries and contribute to department research activities.

The role emphasizes data accuracy, customer service, and documentation updates while working in a collaborative team environment across a national network.

Qualifications

• High School Diploma or Equivalent.
• Detail oriented with demonstrated technical aptitude, capable of learning and applying multiple processes and understanding new computer programs
• Established problem solving skills.
• Adhere to all department policies and procedures while achieving department productivity and turnaround time goals.
• Ability to work well independently and take independent action while also working successfully within a team environment.
• Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint.
• Knowledge of Medical Claim Coding and/or Claim Billing helpful.

Responsibilities

• Manage provider database information including demographics and associated networks.
• Research and communicate any discrepancies or changes to provider data that could potentially affect how a claim is priced or paid.
• Maintain unique provider data to support accurate display on provider search portal.
• Validate contract pricing on paid claim in response to provider appeals and inquiries.
• Provide information and customer service to internal and external customers.
• Assist team in all department research activities.
• Contribute to documentation and updates of all policies and procedures.

Skills

Attention to detail

Independent worker

Team player

Microsoft Office

Medical claim coding knowledge

Education

High School Diploma

Tools

Microsoft Office Suite

Job description

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, Health Plans, Inc. (HPI) is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication - we can't wait to meet you.

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we're known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you'll contribute to ideas that make a real difference for employers and employees nationwide. There isn't a challenge we won't accept and we're looking for people who have a passion to take it on. Not just a job - a mission.

What you'll do

The Provider Pricing Specialist is responsible for managing provider database information, provider association with claim and set up of online customer portals. The Provider Specialist assists with research to settle claim pricing questions, as well as the provider and member appeal process. The Specialist provides assistance in all department research activities.

In this role, you'll also:

• Manage provider database information including demographics and associated networks.
• Research and communicate any discrepancies or changes to provider data that could potentially affect how a claim is priced or paid.
• Maintain unique provider data to support accurate display on provider search portal.
• Validate contract pricing on paid claim in response to provider appeals and inquiries.
• Provide information and customer service to internal and external customers.
• Assist team in all department research activities.
• Contribute to documentation and updates of all policies and procedures.

What you bring

• High School Diploma or Equivalent
• Must be detail oriented with demonstrated technical aptitude, capable of learning and applying multiple processes and understanding new computer programs
• Established problem solving skills.
• Adhere to all department policies and procedures while achieving department productivity and turnaround time goals.
• Ability to work well independently and take independent action while also working successfully within a team environment.
• Proficient in Microsoft Office, including Word, Excel, Outlook and PowerPoint.
• Knowledge of Medical Claim Coding and/or Claim Billing helpful.

Why choose us?

• Our space is a reflection of who we are - innovative, open and collaborative.
• Love to get creative? We do too. Brainstorm in one of our team break-out rooms.
• We think feeling your best is an important factor in producing great work, so we embrace a "smart casual" dress code and work at ergonomic desks.
• Need to reenergize? Take a break to chat in the onsite café, go for a walk on one of the beautiful trails in our office park, or get in a quick workout at one of the campus gyms.
• We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
• We're a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you! We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer to our employees:

• Medical, Dental and Vision Coverage
• Prescription Drug Coverage
• Fitness Reimbursement Benefit
• Employee Assistance Program
• Flexible Spending Account & Health Savings Account
• 401(k) and Profit-Sharing Plan
• Quarterly Bonuses
• Generous Paid-Time Off
• Education Assistance & Professional Development Opportunities
• …and much much more!

You can read more about us at hpitpa.com/about-us/careers/