Remote Provider Pricing & Data Integrity 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

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.