Provider Contract Pricing Specialist

Job
22-118225
Facility
HCS Correctional Claims Management
Type
Full-Time
Shift
Day 8 hour
Recruiter
Jennifer Bates
Recruiter : Email
JCBates@Wellpath.us

Why Wellpath

Here at Wellpath, everything that we do is about taking care of people – our patients, our staff and our partners. We are committed to making a difference by providing hope and healing to vulnerable patients in challenging clinical environments. Our talented, compassionate team thrives in an autonomous environment, is empowered and supported by education, training and the resources to practice healthcare the way it is meant to be and strives to “Always Do The Right Thing!”


 

 

 

About this role

Our 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.

What you bring to the table

Education:

  • Must have high school diploma or GED

Experience:

  • 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 required

What you will do

  1. Conducts multi-state Medicaid research for physician and facility reimbursement calculation.

  2. Maintains multi-state Medicaid reimbursement updates as they occur.

  3. Updates pricing software to properly calculate provider direct contracts based agreed terms.

  4. Assists with other duties within the Provider Relations department regarding provider records, manual pricing of medical claims submitted for reimbursement, and any other duties.

  5. 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.
  6. Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.
  7. Must be alert at all times; pay close attention to details.
  8. Must be able to work under stress on a regular or continuous basis.
  9. Perform other duties as assigned.

Wellpath is an EOE/Minorities/Females/Vet/Disability Employer

Our investment in you

  • Medical, Dental and Vision Insurance plan options
  • Time off & leave benefits
  • 401K
  • Tuition Reimbursement
  • Parental benefits
  • Perks and discounts
  • And more available here https://wellpathcareers.com/

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