JOB DESCRIPTION

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30 years of experience building unique benefit solutions and managing customized health plans.

What is your impact?

The Internal Pricing Coordinator under limited supervision, maintains accurate internal pricing information and configuration for group health plans including, but not limited to, networks, contracts and / or fee schedules in our system.

This role works with internal departments, clients or external vendor partners for configuration and pricing information.

Location :

This is an in office position located at 8500 Freeport Parkway Irving, Texas 75063

What Will You Be Doing :

The essential functions listed represent the major duties of this role, additional duties may be assigned.

• Maintain Internal Pricing configuration for group health plans : (80%) Interpret, create and load provider contracts and fee schedulesDetermine Provider Specialty / Type and link to appropriate reimbursement schedulesMaintain Provider RosterAdd and approve provider and vendor recordsDetermine a provider’s status as either an innetwork or outofnetwork provider, load them into the database, and attach the appropriate contractKnow / understand different provider specialties & types for accurate application to benefit plansVerify accuracy of fee schedule
• Execute communications both internally and externally : (15%) Provide customer service externally to our clients, networks, providersProvide customer service internally to our customer service, claims and account management departmentsProvide clarification on contractual arrangements to internal departments and externally to providers and / or networks
• Metrics and Performance : (5%) Follow established metrics for quality, relevance, and accuracyMeet metrics and client performance guaranteesIdentify and raise with manager continued improvement / training needs

What You Must Have :

• 2 years related work experience in Health plan administration
• High school diploma or GED
• Extensive knowledge of CPT codes, HCPCs, etc.
• Must be able to field client and customer service type phone calls and interact with providers and all office employees on a daily basis.
• Must possess advanced computer skills in utilizing Microsoft Office Word and Excel, and an intermediate knowledge of Microsoft Access and other reporting databases.
• Must possess EDI knowledge.
• Must be able to multitask.
• Ability to prioritize and work independently.

What We Prefer :

• Preferred minimum of 2 years of experience in pricing configuration for PPO, EPO, or HMO health plans.
• Courses in Healthcare Administration preferred

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to :

• Medical, dental, vision, life and global travel health insurance
• Income protection benefits : life insurance, Short and longterm disability programs
• Leave programs to support personal circumstances
• Retirement Savings Plan includes employer contribution and employer match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed.

General Physical Demands :

Sedentary work : Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

We are an Equal Opportunity / Protected Veteran / Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.

Last updated : 2024-05-20