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Salary: USD 65,000 - 65,000 / annual
Yuzu is a tech-enabled Third-Party Administrator (TPA) that powers innovative health plans centered on care navigation, capitated primary care, and real-time payments. The company partners with plan designers to enable custom health plan creation and management, differentiating itself through efficient claims processing, regulatory compliance, and technology that enables custom payment flows.
The Cost Transparency Specialist plays a key role in ensuring accurate, timely, and compliant processing of manual submission medical claims. This position requires strong analytical skills, deep attention to detail, and working knowledge of medical benefit categories.
Key responsibilities include: processing and reviewing manual medical claims submissions with high accuracy; applying knowledge of medical coding (CPT, ICD-10, HCPCS) to ensure proper adjudication and reimbursement; interpreting plan documents and reimbursement methodologies; managing cash-pay workflows; communicating professionally with external partners regarding claims status; educating Plan Designers on claims procedures and documentation requirements; supporting care navigation processes; identifying and escalating claims discrepancies; maintaining HIPAA compliance; and contributing to process improvement initiatives.
The ideal candidate has 2+ years of experience in medical claims processing or reimbursement, working knowledge of medical coding standards, experience with manual claims workflows and EOB review, and familiarity with self-funded health plans. Strong computer skills, empathy, professionalism, accuracy, prioritization ability, excellent communication, critical thinking, and a collaborative team-oriented approach are essential.
Standout qualifications include experience with innovative health plan designs (Reference-Based Pricing, cash payment models, Direct Primary Care), familiarity with HIPAA/CMS/managed care guidelines, ACA compliance knowledge, understanding of reimbursement methodologies, startup or high-growth environment experience, utilization review/management skills, and bilingual capabilities (especially Spanish).
Yuzu offers equity opportunities, competitive salary ($65k annually), health benefits, 401k with employer matching, career growth opportunities, and a high-trust team culture with radical transparency and autonomy.
