CERIS Repricing Quality Assurance Analyst I

Essential Functions & Responsibilities

• Identify and resolve quality issues within repricing processes
• Develop and implement QA policies and procedures
• Monitor compliance with pricing guidelines and contractual requirements
• Investigate repricing discrepancies and apply corrective actions
• Prepare QA reports and documentation
• Collaborate with stakeholders to align quality objectives
• Provide training and guidance on repricing standards
• Conduct risk assessments to mitigate potential errors
• Maintain confidentiality of client data, PHI, and PII

Knowledge & Skills

• Strong understanding of repricing claims processing, and contractual rate application
• Knowledge of healthcare revenue cycle and reimbursement
• Knowledge of applicable regulations and pricing guidelines
• Proficiency in Microsoft Office and multi-platform systems
• Excellent analytical, problem-solving, and communication skills
• High attention to detail with the ability to work in fast-paced environments
• Able to work independently and within a team environment

Education & Experience

• 5+ years in medical/insurance repricing, claims processing, or auditing
• 3+ years in quality assurance or equivalent combination of education and experience
• Repricing or network contracting experience preferred
• High School Diploma or higher required; Associate's or Bachelor's degree preferred