CERIS Repricing Quality Assurance Analyst I - #305377

Job Details

Description

The Repricing Quality Assurance Analyst is responsible for reviewing, analyzing, and monitoring repricing audit data across multiple platforms to ensure accuracy, compliance, and efficiency. Works closely with internal teams to maintain contractual and organizational standards, enhance operational effectiveness, and improve client satisfaction.

This is a remote position.

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
• Additional duties as assigned
  
  

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
• Ability 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
  
  

Pay Range

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $19.21 - $28.73 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

About Ceris

CERiS, a division of CorVel Corporation, a certified Great Place to Work Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.