Cost Transparency Specialist

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $65k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Yuzu

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2022

🏥 Healthcare

🛡️ Insurance

☁️ SaaS

Healthcare • Insurance • SaaS

Yuzu is a technology platform that lets organizations design, launch, and operate custom health plans and modernize third-party administrator (TPA) workflows. It provides a Benefits Builder to configure tiers, accumulators, and benefits; integrations with PBMs, stop-loss carriers, and other vendors; automated document generation and e-signature; web-based portals for employers, members, and vendors; in-house claims adjudication and payment infrastructure with real-time auto-ledgering; and reporting and support tools. Yuzu emphasizes white-labeling so customers can present fully branded plans and handles end-to-end plan operations from onboarding to live plan management.

📋 Description

• Process and review manual medical claims submissions accurately and with attention to detail • Apply CPT, ICD-10, and HCPCS coding knowledge for adjudication and reimbursement • Interpret plan documents and reimbursement methodologies according to benefit design • Manage cash-pay workflows, including documentation review and compliant processing • Communicate with external partners about claims status, submission requirements, and processing details • Educate Plan Designers on claims procedures, reimbursement timelines, and required documentation • Support care navigation through accurate documentation and service coordination • Identify, investigate, and escalate claims discrepancies or unresolved issues • Maintain confidentiality and follow HIPAA guidelines and compliance standards • Contribute to claims operations and support process improvement initiatives • Participate in interviews involving leadership conversations, a take-home assignment, and reference checks

🎯 Requirements

• 2+ years of experience in medical claims processing or reimbursement preferred • Working knowledge of CPT, ICD-10, and HCPCS coding • Experience with manual claims workflows and explanation of benefits (EOB) review • Familiarity with self-funded health plans and employer-sponsored benefits preferred • Proficiency with computer skills • Empathy and professionalism when communicating with clients and partners • Strong commitment to accuracy and attention to detail • Ability to prioritize workload effectively in a fast-paced environment • Excellent written and verbal communication skills • Critical thinking and problem-solving ability • Dependability, accountability, and ownership mindset • Collaborative, team-oriented approach • Experience with innovative health plan designs, including Reference-Based Pricing (RBP), cash payment models, care navigation, and employer-sponsored Direct Primary Care (DPC) • Familiarity with HIPAA, CMS, or managed care guidelines • Knowledge in ACA compliant plans • Strong understanding of reimbursement methodologies • Experience in a startup or high-growth environment • Utilization Review and Utilization Management skills • Bilingual skills, especially Spanish

🏖️ Benefits

• Equity opportunities • Health benefits • 401K with Employer matching • Career growth and development opportunities • Remote capabilities • High-trust team with radically high transparency and autonomy