External Pricing Coordinator

Job Summary
Under limited supervision, maintains accurate external pricing information and configuration for group health plans including, but not limited to, networks, contracts and/or fee schedules in our system. Working with external vendor partners for configuration and pricing information.

Essential Functions

• The essential functions listed represent the major duties of this role, additional duties may be assigned.
• Maintain External Pricing configuration for group health plans:
  
  - Evaluate and manually price both professional and institutional medical claims with external vendors
  
  - Review and correct errors identified in keying medical claims
  
  - Communicate with networks to verify pricing information and resolve claim issues
  
  - Know/understand different provider specialties & types for accurate application to benefit plans
  
  - Add and approve provider and vendor records
  
  - Monitor claim flow through external networks & EDI Processes (80%)
• Execute communications both internally and externally:
  
  - Provide customer service externally to our clients, networks, providers
  
  - Provide customer service internally to our customer service, claims and account management departments
  
  - Provide clarification on contractual arrangements to internal departments and externally to providers and/or networks (15%)
• Metrics and Performance:
  
  - Follow established metrics for quality, relevance, and accuracy
  
  - Meet metrics and client performance guarantees
  
  - Identify and raise with manager continued improvement/training needs (5%)

Required Work Experience
2+ years related work experience. Experience Details: Health plan administration

Required Management Experience
No supervisory/management experience required

Required Education
High school diploma or GED Health Administration preferred

Additional Required Qualifications

Extensive knowledge of CPT codes, HCPCs, etc.
Must be able to field client and customer service type phone calls and interact with providers and all office employees on a daily basis.
Must possess advanced computer skills in utilizing Microsoft Office Word and Excel, and an intermediate knowledge of Microsoft Access and other reporting databases.
Must possess EDI knowledge.
Must be able to multitask.
Ability to prioritize and work independently.

Additional Preferred Qualifications• Preferred minimum of 2 years of experience in pricing configuration for PPO, EPO, or HMO health plans.

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.