Internal Pricing Coordinator

Job Summary

Under limited supervision, maintains accurate internal pricing information and configuration for group health plans including, but not limited to, networks, contracts and/or fee schedules in our system. Working with internal departments, clients or 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 Internal Pricing configuration for group health plans:
  - Interpret, create and load provider contracts and fee schedules
  - Determine Provider Specialty/Type and link to appropriate reimbursement schedules
  - Maintain Provider Roster
  - Add and approve provider and vendor records
  - Determine a provider's status as either an in-network or out-of-network provider, load them into the database, and attach the appropriate contract
  - Know/understand different provider specialties & types for accurate application to benefit plans
  - Verify accuracy of fee schedule (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

Additional Required Qualifications

• Extensive knowledge of CPT codes, HCPCs, EDI
• Ability to field client and customer service type phone calls and interact with providers and all office employees on a daily basis.
• Advanced computer skills in Microsoft Word and Excel, and intermediate knowledge of Microsoft Access.

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.