Correct Care Solutions
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Provider Contract Pricing Specialist
at Correct Care Solutions
Our Provider Contract Pricing Specialist will provide research on a multi-state level regarding individual state Medicaid medical reimbursement rules and applicable rates; provide medical claims pricing submitted for reimbursement; and audit Medicare and individual provider contracts for correct medical reimbursement calculations.
- Must have high school diploma or GED
- Minimum two (2) years work history in related field.
- Experience in healthcare is required.
- Experience with medical provider billing is required, prefer rounded knowledge in respect to physicians and facilities.
- Experience in Medicaid reimbursement rules is a plus.
- Willing to research, learn, and build knowledge base for multi-state Medicaid.
- None required
Conducts multi-state Medicaid research for physician and facility reimbursement calculation.
Maintains multi-state Medicaid reimbursement updates as they occur.
Updates pricing software to properly calculate provider direct contracts based agreed terms.
Assists with other duties within the Provider Relations department regarding provider records, manual pricing of medical claims submitted for reimbursement, and any other duties.
- Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.
- The above responsibilities are a highlight of responsibilities and not a full list. Other responsibilities may be performed as assigned.