Provider Pricing Specialist

April 1

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Health Plans, Inc.

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Health Plans, Inc. (HPI) is a leading national third-party administrator (TPA) that specializes in self-funding solutions for employers and benefits brokers. HPI offers innovative health plan designs, including Consumer-Driven Health Plans (CDHP) and reference-based pricing, tailored to meet the unique needs of individual markets. With a commitment to providing advanced analytics and customized solutions, HPI aims to put employers in control of their healthcare costs while enhancing the member experience.

Health Benefits Company • Population Health Management • Self-Funding • Health and Wellness

201 - 500 employees

Founded 1981

⚕️ Healthcare Insurance

💳 Fintech

🤝 B2B

📋 Description

• The Provider Pricing Specialist is responsible for managing provider database information, provider association with claim and set up of online customer portals. • The Provider Specialist assists with research to settle claim pricing questions, as well as the provider and member appeal process. • The Specialist provides assistance in all department research activities. • Manage provider database information including demographics and associated networks. • Research and communicate any discrepancies or changes to provider data that could potentially affect how a claim is priced or paid. • Maintain unique provider data to support accurate display on provider search portal. • Validate contract pricing on paid claim in response to provider appeals and inquiries. • Provide information and customer service to internal and external customers. • Assist team in all department research activities. • Contribute to documentation and updates of all policies and procedures.

🎯 Requirements

• High School Diploma or equivalent education • Must be detail oriented with demonstrated technical aptitude, including the ability to learn and apply multiple processes and adapt to new computer programs • Proven problem-solving skills with the ability to analyze and resolve issues effectively • Adhere to all department policies and procedures while achieving department productivity and turnaround time goals • Excellent communication skills, both written and verbal • Ability to work well independently and take independent action while also working successfully within a team environment • Proficiency in Microsoft Office Suite, including Word, Excel, Outlook and PowerPoint • Knowledge of medical claim coding and/or claim billing is a plus

🏖️ Benefits

• Medical, Dental and Vision Coverage • Prescription Drug Coverage • Fitness Reimbursement Benefit • Tobacco Cessation Program • Employee Assistance Program • Flexible Spending Account & Health Savings Account • 401(k) and Profit-Sharing Plan • Quarterly Bonuses • Generous Paid-Time Off • Volunteer Days • Education Assistance & Professional Development Opportunities • ...and much much more!