Claims Repricing Specialist

📋 Description

• Reprice claims using PPO fee schedules, DRG/APC methods.
• Validate line- and claim-level allowed amounts before adjudication.
• Interpret contracts to determine pricing intent and rules.
• Translate contract language into repricing configuration.
• Identify conflicts between terms and system logic; propose resolution.
• Collaborate with partners to test pricing changes and resolve issues.

🎯 Requirements

• High School diploma required; Bachelor's preferred.
• 3-5 years in healthcare claims, repricing, or payment integrity.
• Knowledge of CPT/HCPCS coding, revenue codes, DRG/APC structures.
• PPO reimbursement methods and fee schedules.
• Proficiency with repricing tools and payor portals.
• Nice to have: RBP, dialysis pricing, transplant pricing.
• Provider appeals background and adjudication platforms helpful.

🎁 Benefits

• Hybrid work with in-office two weekdays per week in Lehi, UT.
• Health insurance and 401(k).
• Paid time off.
• 10,000 stock options.
• Professional development and internal mobility.