Repricing Associate (Temporary)

Accountabilities

Medical billing and data entry: Enter billing information and Medicare reporting data accurately while verifying ICD-10 and CPT-4 codes to support appropriate medical bill repricing.
Regulatory compliance: Research and respond to inquiries within established turnaround times, ensuring compliance with applicable state laws and Medicare requirements.
EDI claims processing: Investigate electronic data interchange (EDI) claim rejections, resolve processing issues, and apply manual repricing when necessary.
Reconsiderations and appeals: Process and administer billing reconsiderations and appeals, coordinating with vendors and provider networks to support timely and accurate resolutions.
Provider payment investigations: Research returned provider checks, investigate reimbursement inquiries, and process requests related to payment discrepancies.
Reporting and documentation: Prepare comprehensive reports, maintain accurate records, and track inquiries and assigned tasks with minimal supervision.
Vendor and network coordination: Participate in quarterly oversight meetings with preferred provider organization (PPO) networks and vendors to support effective collaboration and service quality.
Cross-functional support: Cross-train on provider network responsibilities within the department and assist with additional operational duties as business needs evolve.
Workflow and workload management: Prioritize assignments, navigate multiple systems simultaneously, and consistently meet deadlines and service standards.
Customer service: Communicate professionally with internal and external stakeholders to resolve questions, clarify billing issues, and maintain positive working relationships.
Requirements
Medical billing experience: Previous experience working in a medical billing environment is required.
Education: A college degree or college-level education is preferred.
Medical coding knowledge: A thorough understanding of billing and coding procedures, including familiarity with ICD-10 and CPT-4 codes, and a solid understanding of medical terminology.
Medicare knowledge: Familiarity with Medicare and Centers for Medicare & Medicaid Services (CMS) requirements is necessary.
Coding certifications: Relevant medical coding accreditations are an advantage.
Regulatory awareness: Ability to apply state-specific requirements, compliance standards, and turnaround time expectations to medical bill repricing activities.
Technical proficiency: Strong computer skills and the ability to navigate multiple software applications and screens efficiently.
Microsoft Office and collaboration tools: Proficiency with Microsoft Word, Excel, Outlook, Teams, Slack, Zoom, and internet-based applications.
Analytical and reporting skills: Ability to investigate billing and reimbursement discrepancies, prepare detailed reports, and manage assigned tasks with minimal guidance.
Communication skills: Excellent written and verbal communication skills, with the ability to interact professionally with providers, vendors, and internal colleagues.
Attention to detail: Strong organizational skills and a commitment to accurate data entry, coding verification, documentation, and claims processing.
Time management: Ability to multitask, prioritize competing assignments, and meet deadlines in a fast-paced environment.
Independent and collaborative working style: Comfortable working autonomously while contributing effectively to a virtual team.
Adaptability: A flexible, self-motivated approach and a willingness to embrace changing priorities, learn new processes, and cross-train on departmental responsibilities.
Remote work readiness: Reliable internet access and the ability to work effectively in a fully remote environment.
Customer service orientation: Strong service skills and a proactive approach to resolving inquiries and addressing stakeholder concerns.
Benefits
Competitive hourly pay: $24–$29 per hour, depending on qualifications, geographic location, and other applicable factors.
Fully remote work: Work from anywhere in the United States.
Full-time temporary opportunity: Expected duration through Q2 2027.
Professional experience: Gain hands-on experience in medical bill repricing, workers' compensation claims operations, Medicare reporting, and reimbursement processes.
Cross-training opportunities: Develop broader knowledge of provider network operations and related departmental responsibilities.
Collaborative virtual environment: Work with internal teams, external vendors, and healthcare provider networks.
Skill development: Strengthen your expertise in medical coding verification, regulatory compliance, claims reconsiderations, and billing issue resolution.