Pricing Resolution Specialist

Summary

Join MedReview, a leader in payment integrity solutions, and contribute to our mission of bringing accuracy, accountability, and clinical excellence to healthcare. This role involves pricing and analyzing inpatient medical claims using various systems and platforms. You will support different departments with claim-related questions and ensure accurate reimbursement. The position requires reviewing data, comparing it with documentation, and determining appropriate pricing. You will work with adjudication software and possess strong analytical and problem-solving skills in healthcare claim adjudication. A high school diploma or equivalent and 5+ years of relevant experience are required.

Requirements

• 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

Responsibilities

• Review data in the review application and client claim processing system, and compare with corresponding UB, medical record or other documentation
• Review all necessary documentation as necessary to determine appropriate reimbursement for a claim
• Review 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

Benefits

Salary: $26.50- 30.00 per hour