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.