[Remote] CERIS Repricing Quality Assurance Analyst I
Note: The job is a remote job and is open to candidates in USA. CorVel Corporation is a certified Great Place to Work® Company that offers healthcare payment solutions. They are seeking a Repricing Quality Assurance Analyst I who will be responsible for reviewing and monitoring repricing audit data to ensure compliance and efficiency while collaborating with internal teams to enhance operational effectiveness.
Responsibilities
- Identify and resolve quality issues within repricing processes
- Develop and implement QA policies and procedures
- Monitor compliance with pricing guidelines and contractual requirements
- Investigate repricing discrepancies and apply corrective actions
- Prepare QA reports and documentation
- Collaborate with stakeholders to align quality objectives
- Provide training and guidance on repricing standards
- Conduct risk assessments to mitigate potential errors
- Maintain confidentiality of client data, PHI, and PII
- Additional duties as assigned
Skills
- Identify and resolve quality issues within repricing processes
- Develop and implement QA policies and procedures
- Monitor compliance with pricing guidelines and contractual requirements
- Investigate repricing discrepancies and apply corrective actions
- Prepare QA reports and documentation
- Collaborate with stakeholders to align quality objectives
- Provide training and guidance on repricing standards
- Conduct risk assessments to mitigate potential errors
- Maintain confidentiality of client data, PHI, and PII
- Strong understanding of repricing claims processing, and contractual rate application
- Knowledge of healthcare revenue cycle and reimbursement
- Knowledge of applicable regulations and pricing guidelines
- Proficiency in Microsoft Office and multi-platform systems
- Excellent analytical, problem-solving, and communication skills
- High attention to detail with the ability to work in fast-paced environments
- Ability to work independently and within a team environment
- 5+ years in medical/insurance repricing, claims processing, or auditing
- 3+ years in quality assurance or equivalent combination of education and experience
- High School Diploma or higher required
- Repricing or network contracting experience preferred
- Associate's or Bachelor's degree preferred
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- Vision
- Long Term Disability
- Health Savings Account
- Flexible Spending Account Options
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- Pre-paid Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- Paid time off
Company Overview
Company H1B Sponsorship