Repricing Quality Assurance Analyst I
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.
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