MEDICAL CLAIMS REPRICER I

Position Overview:

USA Managed Care Organization (USA MCO) is a leader in providing nationwide healthcare access with a focus on helping control the escalating cost of healthcare for the consumer while respecting the providers’ ultimate authority in the treatment of the patient. USA MCO’s Health and Wellness Network is the nation’s largest, single source, self-developed, privately held Preferred Provider Organization, serving millions of covered lives.

USA MCO is currently seeking a full-time highly organized and detail-oriented Medical Claims Repricer. This is a paperless processing role with little to no inbound/outbound calls per day. This position is in office Monday through Friday, 8:00 – 4:30 at 4609 Bee Caves Rd Suite 200, Austin, TX 78746.

Key Responsibilities:

• Adhere to HIPAA, Confidentiality, and Security requirements
• Reprice Medical Claims using HCFA and UB forms, as well as system information, focusing on procedural, contractual, and overall accuracy throughout the process
• Achieve clearly defined production and quality metrics as defined by role, length of service, etc.
• Occasional overtime due to volume and turnaround-time requirements
• All other job duties as assigned

Qualifications

• Education: High School diploma/GED
• Minimum 2 years of recent claims-processing experience with ICD/CPT coding
  • Experience with Group PPO plans in a multi-tenant environment, a plus
• General computer knowledge, with ability to learn multiple systems and independent transition between home and office locations when needed
  • Experience with AS400/iSeries, a plus

• Meticulous attention to detail
• Strong work ethic and drive
• Ability to communicate effectively and respectfully
• Professional demeanor and coachable attitude