Provider Pricing Appeals Specialist (Remote)

Do you envision working for a company that has the expertise of a long-standing industry leader, but the spirit of an entrepreneur? Does the thought of making a real impact motivate and energize you? If so, Health Plans, Inc. (HPI) is the place for you. Join a team that values integrity, flexibility, loyalty, compassion and dedication—we can’t wait to meet you.

What we do

HPI is unique. A respected industry leader that’s been serving customers for over 40 years, we’re known for our innovation and growth. Our experience has given us our expertise, but our forward-thinking, entrepreneurial spirit has given us our strong reputation. As a third-party administrator, we offer a suite of health and benefit solutions to employers. By joining HPI, you’ll contribute to ideas that make a real difference for employers and employees nationwide. There isn’t a challenge we won’t accept and we’re looking for people who have a passion to take it on. Not just a job—a mission.

What you’ll do

The Provider Pricing Appeals Specialist, under the direction of the Supervisor of Provider Pricing, will handle provider appeals as it relates to resolving provider payment disputes. Work with other departments, prepare cases for review, and send correspondence.  

In this role, you’ll also: 

• Review claims and medical documentation with regards to appeals from providers 
• Prepare cases for clinic review, NSA and IDR
• Prepare all DOI complaints with regards to pulling claims, EOB’s and drafting letter for approval and sending correspondence
• Provide accurate and timely responses to appeals, grievances and all other correspondence
• Research and document pertinent information on claims requiring adjudication
• Work with team to identify system issues and communicate ways to improve
• Keep open communication among all teams/departments
• Perform other various tasks that are deemed necessary and equitable by management

What you bring

• High Diploma or equivalent education
• Ability to multitask efficiently and accurately
• Ability to prioritize and multitask effectively
• Communicates effectively, both verbally and in writing
• Ability to work both independently and as a member of the team
• Ability to anticipate and understand systems interactions
• Must be detailed, analytical and accurate
• Recognize the need for follow-thru and follow-up 
• Ability to work within specified timeframe and meet deadlines
• Recognize and maintain confidentiality of work materials as appropriate
• Proficient with Microsoft Word and Excel or similar PC based programs
• Demonstrated knowledge and working ability with HealthPac and /or Javelina preferred

Why choose us?

• Our space is a reflection of who we are—innovative, open and collaborative.
• We offer our employees flexible work arrangements including remote and hybrid options (depending on the position)
• We’re a people-first company and value giving back to our community. Ask us about our RISE Committee & and volunteer opportunities.

Benefits

We care about you and believe the greatest gift you can give yourself, your family, and the world is a healthy you!  We offer a comprehensive and competitive benefits package to help you lead a happy, healthy life. Check out some of the benefits we offer to our employees:

• Medical, Dental and Vision Coverage
• Prescription Drug Coverage
• Fitness Reimbursement Benefit
• Tobacco Cessation Program
• Employee Assistance Program
• Flexible Spending Account & Health Savings Account
• 401(k) and Profit-Sharing Plan
• Quarterly Bonuses
• Generous Paid-Time Off 
• Volunteer Days
• Education Assistance & Professional Development Opportunities
• ….and much much more!

So, think you want to join the HPI team? We hope to hear from you!

You can read more about us at hpitpa.com/about-us/careers/

EEO/AA/M/F/Vet/Disability Employer