Medical Claim Pricing Coordinator (External)

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

What is your impact?

The External Pricing Coordinator role maintains accurate external pricing information and configuration for group health plans. This includes network, contracts and/or fee schedules in our system. This position will also work with external vendor partners for configuration and pricing information.

What Will You Be Doing:

Maintain External Pricing configuration for group health plans:

Evaluate and manually price both professional and institutional medical claims with external vendors

Review and correct errors identified in keying medical claims

Communicate with networks to verify pricing information and resolve claim issues

Know/understand different provider specialties & types for accurate application to benefit plans

Add and approve provider and vendor records

Monitor claim flow through external networks & EDI Processes

Execute communications both internally and externally:

Provide customer service externally to our clients, networks, providers

Provide customer service internally to our customer service, claims and account management departments

Provide clarification on contractual arrangements to internal departments and externally to providers and/or networks

Metrics and Performance:

Follow established metrics for quality, relevance, and accuracy

Meet metrics and client performance guarantees

Identify and raise with manager continued improvement/training needs

Qualifications:

2+ years related work experience working with PPO, EPO, or HMO health plans.

Knowledge of CPT codes, HCPCs, etc.

Advanced computer skills in utilizing Microsoft Office

Preferred knowledge of Microsoft Access

Preferred knowledge of EDI transactions

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

Medical, dental, vision, life and global travel health insurance

Income protection benefits: life insurance, Short- and long-term disability programs

Leave programs to support personal circumstances.

Retirement Savings Plan includes employer contribution and employer match

Paid time off, volunteer time off, and 11 holidays

Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands:

Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.