Imagine360 is currently seeking a Pricing Specialist to join our team! This Pricing Specialist is responsible for maintaining new and current provider and PPO information in the claims software system. This position also ensures the accuracy of repricing and claim disputes and appeals information.

Position Location: 100% Remote

Responsibilities include but are not limited to:

• Validate and Maintain Provider Information
• Verifying provider data from internal and external sources to maintain claims system functionality
• Maintains accurate provider information
• Repricing and Claim Appeals
• Ensures providers are affiliated to the appropriate PPO after repricing to ensure accurate payment for claims.
• Contacts providers for necessary information and documents information appropriately
• Verifies effective and termination dates for providers with the PPO to ensure correct repricing.
• PPO Information
• Ensures accurate PPO or contract information is current in claims processing system in order to ensure correct discount and payment of claims
• Proactively identifies the need to contact provider or PPO for additional or missing information as necessary.
• Researches repricing appeals from PPOs and providers.
• Works with PPO contacts to confirm contract discount rate and verification of claims submitted
• Relays decision of PPO of payment to Claims Examiner for release of claim.
• Customer Service
• Acts as a role model in demonstrating the core values in customer service delivery.
• Provides timely and thorough follow up with, internal and external customers.

• Appropriately escalates difficult issues up the chain of command.
• Quality Assurance
• Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction.
• Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
• Performs self-quality monitoring in order to develop and execute plans to meet established goals.
• Provides ongoing feedback to help optimize quality performance.
• Collaborates with others and cross-departmentally to improve or streamline procedures.
• Develops new or improves current internal processes to improve quality

Required Experience / Education:

• High school diploma or GED required
• 1+ years of medical office/clerical experience

Skills and Abilities:

• Proficient typing and 10 key skills
• High level critical thinking skills Working knowledge of computers and software including but not limited to Microsoft Office products
• Experience and comfort in using multiple complex computer programs
• Demonstrated leadership, organizational, problem-solving, and analytical skills as well as detailed oriented
• Strong written, telephonic and oral communication skills
• Demonstrated ability to work independently, prioritize workloads, multi-task and manage priorities in order to meet deadlines

What can Imagine360 offer you?

• 100% Company-Paid Premiums for Employee's Medical, Vision and Dental Plans
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**