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Provider Contract Pricing Specialist

Company: Wellpath
Location: Hendersonville
Posted on: January 16, 2020

Job Description:

OverviewOur Provider Contract Pricing Specialist will provide research on a multi-state level regarding individual state Medicaid medical reimbursement rules and applicable rates; provide medical claims pricing submitted for reimbursement; and audit Medicare and individual provider contracts for correct medical reimbursement calculations.QualificationsEducation:

  • Must have high school diploma or GEDExperience:
    • Minimum two (2) years work history in related field.
    • Experience in healthcare is required.
    • Experience with medical provider billing is required, prefer rounded knowledge in respect to physicians and facilities.
    • Experience in Medicaid reimbursement rules is a plus.
    • Willing to research, learn, and build knowledge base for multi-state Medicaid.Licenses/Certifications:
      • None requiredResponsibilities
        • Conducts multi-state Medicaid research for physician and facility reimbursement calculation.
        • Maintains multi-state Medicaid reimbursement updates as they occur.
        • Updates pricing software to properly calculate provider direct contracts based agreed terms.
        • Assists with other duties within the Provider Relations department regarding provider records, manual pricing of medical claims submitted for reimbursement, and any other duties.
        • Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.
        • Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.
        • Must be alert at all times; pay close attention to details.
        • Must be able to work under stress on a regular or continuous basis.
        • Perform other duties as assigned.Wellpath is an EOE/Minorities/Females/Vet/Disability EmployerNot ready to apply? Connect with us to be the first to hear about new opportunitiesJoining our Talent Community will enhance your job search and application process. Receive alerts with new job opportunities that match your interests Receive relevant communications and updates from Wellpath. Share job opportunities with family and friends through Social Media or emailSo,to Join our Talent Community today!Job 19-73302Location TN, HendersonvilleFacility Health Cost SolutionsType Full-TimeShift Day 8 hourRecruiter Jennifer BatesEmail JCBates@Wellpath.us

Keywords: Wellpath, Hendersonville , Provider Contract Pricing Specialist, Other , Hendersonville, Tennessee

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