Job Description
Claims Repricer Position Summary The Claims Repricer is responsible for reviewing, analyzing, and repricing medical claims according to provider contracts, fee schedules, and client-specific reimbursement arrangements. This role ensures claims are priced accurately, efficiently, and in compliance with contractual and regulatory requirements. Office hours are Monday through Thursday from 8:00 a.m. to 5:00 p.m. and Friday from 8:00 a.m. to 4:00 p.m. Essential Duties and Responsibilities Claims Review and Repricing Review and reprice professional (HCFA) and institutional (UB-04) medical claims. Apply provider contract terms, fee schedules, reimbursement methodologies such as case rates, per diem, DRGs, APCs, ASC rates, and percentage-of-charge agreements. Analyze claim details, coding, and reimbursement methodologies to determine accurate payment allowances. Ensure claims are processed in accordance with network agreements and client-specific requirements. Research and Resolution Investig...