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%)

Qualifications

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.