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Pricing Resolution Specialist
@MedReview
[Hiring] Pricing Resolution Specialist @MedReview
Mar 26, 2025 - MedReview is hiring a remote Pricing Resolution Specialist. 💸 Salary: $26.50-30.00 per hour. 📍Location: USA.
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Role Description
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.
- 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
Requirements
- Salary: $26.50- 30.00 per hour
- Experience Requirements: Mid Level
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| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
Back to Remote jobs >
All others
All others
|
Salary
💸
$26.50-30.00 per hour
|
Remote
Location
USA
|
|
Job Type
full-time
|
Posted
Mar 26, 2025
|
️
| 📍 | Be aware of the location restriction for this remote position: USA |
| ‼ | Beware of scams! When applying for jobs, you should NEVER have to pay anything. Learn more. |
