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Provider Contract Pricing Specialist

Company: Wellpath
Location: Hendersonville
Posted on: February 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 Employer

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

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