JOB SUMMARY:
The Pricing Specialist plays a vital role in supporting the financial integrity and reimbursement
optimization of the organization by negotiating pricing agreements with third-party payers and repricing
networks such as Multiplan, Zelis, Data iSight, and others. This position involves close collaboration with
internal departments including Billing, Claims, and Utilization Review (UR), as well as consistent
communication with insurance companies and external payer representatives.
The ideal candidate is detail-oriented, proactive, and highly skilled in negotiation, documentation, and
cross-functional collaboration.
PREFERENCES:
● Experience working the medical billing field.
● Strong knowledge of claims adjudication process and insurance terminology.
● Highly skilled in negotiation, documentation, and cross-functional collaboration.
QUALIFICATIONS:
● Attention to detail and the ability to work with complex documents.
● Proficient in using contract management software.
RESPONSIBILITIES:
Negotiate pricing arrangements with third-party networks and repricing services (e.g.,
Multiplan, Zelis, Data iSight, Viant, etc.) to ensure optimal reimbursement rates.
Conduct outreach via phone and email to insurance companies and third-party payers to verify
pricing, resolve discrepancies, and confirm payment arrangements.
Maintain detailed and accurate documentation of all negotiations, communications, and
outcomes in internal systems.
Collaborate closely with Billing, Claims, and Utilization Review teams to resolve pricing-related
issues and support timely claim resolution.
Utilize historical pricing data and trends to secure the highest possible reimbursement rates
during negotiations.
Initiate and manage post-payment repricing efforts, ensuring timely and accurate submission to
third-party pricers and payers.
Escalate complex negotiations or discrepancies to leadership as appropriate.
Stay informed of industry pricing trends, payer behavior, and regulatory changes affecting
reimbursement.
Submit pricing appeals and follow through on special pricing projects as assigned.
Actively seek out and identify low or underpaid accounts across all facilities for repricing
opportunities.
Research and respond to account inquiries related to pricing via phone, email, or written
correspondence
Maintain internal deadlines and ensure compliance with pre-payment and post-payment
negotiation timelines.
Collect and analyze pricing data to identify reimbursement trends, payer performance, and
opportunities for negotiation.
● Stay updated on industry regulations and best practices related to billing guidelines and
contract management. Stay informed about industry regulations and best practices in
contract management.
● Performs miscellaneous job-related duties as assigned.
PHYSICAL DEMANDS & WORK ENVIRONMENT:
The physical demands described here are representative of those that an employee must meet to perform the essential functions of this position successfully. Reasonable accommodation may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or listen. The employee is frequently required to use their hands or fingers and handle or feel objects, tools, or controls. The employee is occasionally required to stand, walk, sit, and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.
Job Type: Full-time
Pay: $20.00 - $25.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Application Question(s):
- Are you able to work in office Mon-Thurs and WFH Fri?
- Do you have any mental health or substance abuse work experience?
Work Location: In person
