Pricing Resolution Specialist
20220630203832 Cp8zt4ib7ber9qxl
Apply to this job Remote Until 8/23/2026 First posted March 20, 2025 Last posted March 20, 2025
Job description
Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier, and Readmission reviews.
Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures. Provide support to various departments related to claim status, claim adjudication questions, and any basic questions related to the adjudication of an inpatient medical claim.
Responsibilities:
This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of MedReview Operations in general.
Qualifications:
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier, and Readmission reviews.
Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures. Provide support to various departments related to claim status, claim adjudication questions, and any basic questions related to the adjudication of an inpatient medical claim.
Responsibilities:
This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of MedReview Operations in general.
- Responsible for reviewing data in the review application and client claim processing system, and comparing with corresponding UB, medical record or other documentation.
- Responsible for reviewing all necessary documentation as necessary to determine appropriate reimbursement for a claim.
- Responsible for reviewing adjudication software system’s claim and line items for determination of how to price a claim / line item.
- Possess ability to work at a computer for extended periods.
- Other duties as assigned.
Qualifications:
- High School Diploma or Equivalent
- Minimum of 5 years related work experience. Prior experience with claim adjudication systems, grouping and pricing software, and other claim adjudication and claim pricing systems.
- Basic knowledge of medical terminology.
- Good knowledge of Microsoft Word, Excel and Outlook
- Intermediate mathematics aptitude
- Basic communication skills
- Proficient organizational abilities
- Proficient comprehension capabilities
- Ability to prioritize multiple tasks
- Experience with UB/inpatient institutional claims
- Proficient knowledge of Medicare and Medicaid billing & payment and coverage guidelines
- Strong experience in the analysis and processing of claims, quality assurance, CMS payment methodologies (i.e., DRGs, Cost Outliers)
- Must be able to work with minimal supervision
- Creative thinker with good skills at problem resolution specifically related to healthcare claim adjudication
About this role
Summary
Review and analyze inpatient medical claims for accurate pricing.
Job title
Pricing Resolution Specialist
Experience level
5+ years
Industry
healthcare
Location requirements
Remote work allowed for this position.
Salary
$26.50-30.00 per hour
Management role
No
Skills & keywords
Required skills
high school diplomaclaim adjudication systemsgrouping softwaremedical terminologymicrosoft wordmicrosoft excelmicrosoft outlookmathematicscommunicationorganizational abilitiescomprehensionprioritize tasksub claimsmedicare billingmedicaid billingclaims analysiscms payment methodologies
Preferred skills
None specified
Specializations
claim adjudicationmedical terminologybillinganalysisproblem resolution
Locations
Structured locations inferred from the posting.
United States
Remote Country