Medical Claims Repricer I
USA Managed Care Organization (USA MCO) – Austin, TX
Full-Time | In-Office | Monday–Friday
About Us
USA Managed Care Organization (USA MCO) is a leader in providing nationwide healthcare access with a focus on helping control the rising cost of healthcare while respecting providers’ authority in patient treatment. Our Health and Wellness Network is the nation’s largest, self-developed, privately held Preferred Provider Organization, serving millions of covered lives.
We are currently seeking a Medical Claims Repricer I to join our growing Claims Repricing team. This is a paperless processing role with minimal phone activity and strong career growth potential.
We highly value candidates with medical claims repricing experience; however, we also welcome motivated, detail-oriented individuals who are eager to learn and grow into a successful Repricer through training and hands-on development.
Position Summary
The Medical Claims Repricer I is responsible for reviewing and repricing medical claims for procedural, contractual, and pricing accuracy while meeting production and quality standards. This role works closely with multiple departments, as claims repricing is a key function that supports organization-wide operations.
Key Responsibilities
- Maintain strict compliance with HIPAA, confidentiality, and security standards
- Reprice medical claims using HCFA and UB forms with focus on accuracy and contract compliance
- Meet established production and quality performance metrics
- Collaborate with internal departments to support cross-functional workflows and repricing operations
- Participate in cross-training to broaden repricing and operational knowledge
- Assist with occasional overtime based on claim volume and turnaround needs
- Perform additional duties as assigned
Qualifications
Required:
- High School Diploma or GED
- Strong computer skills and ability to learn multiple systems
- High attention to detail and accuracy
- Professional communication and teamwork skills
- Reliable, coachable, and growth-oriented mindset
Preferred (but not required):
- 2+ years of recent medical claims processing or repricing experience
- Experience with ICD/CPT coding
- PPO / Group plan experience in a multi-tenant environment
- AS400 / iSeries experience
Candidates without direct repricing experience but with strong analytical ability and willingness to learn are encouraged to apply.
Work Environment & Schedule
- Location: Austin, TX (This is a full-time, in-office role)
- Schedule: Monday – Friday, 8:00 AM – 4:30 PM CT (37.5 hours/week, 1-hour lunch)
- Business Casual dress code
- Company laptop provided
Why Join USA MCO?
- Stable and growing organization
- Career development and advancement opportunities
- Hands-on training and cross-department exposure
- Team-oriented, professional environment
Job Type: Full-time
Pay: $20.00 - $30.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Paid time off
- Vision insurance
Application Question(s):
- What are your pay expectations
Experience:
- recent medical claims-processing : 2 years (Preferred)
Ability to Commute:
- West Lake Hills, TX 78746 (Required)
Work Location: In person
