MedReview is hiring a
Team Lead, Inpatient Claims Pricing Specialist, Remote - Worldwide

Summary

The job is for a Pricing Analyst at MedReview, involving pricing and analysis of inpatient medical claims, providing support to various departments, and acting as a resource for all pricing team members. The position allows telecommuting from anywhere within the United States.

Requirements

• Associates degree preferred
• Minimum of 5 years management experience
• 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. Ie; Facets, Cosmos, CAS, WebStrat, Encoder
• Experience with pricing reject resolution
• Basic knowledge of medical terminology
• Good knowledge of Microsoft Word, Excel and Outlook
• Intermediate mathematics aptitude
• Good communication skills
• Good organizational abilities
• Ability to prioritize multiple tasks
• Experience with UB/institutional claims
• 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
• High speed internet (300 Mbps per person recommended) with secured WIFI

Responsibilities

• Serves as a knowledge expert and maintains up to date working knowledge of pricing guidelines
• Reviews data in the review application and client claim processing system, and compares with corresponding UB, medical record or other documentation
• Reviews all necessary documentation as necessary to determine appropriate reimbursement for a claim
• Reviews adjudication software system’s claim and line items for determination of how to price a claim / line item
• Performs quality reviews on individual team members ensuring all claims are completed timely and per department standards
• Identifies education needs within the department to facilitate pricing accuracy improvement
• Works collaboratively with Assistant Director of Pricing to analyze and optimize processes to maintain acceptable productivity rates for each individual team member
• Works collaboratively with Assistant Director in developing educational tools for new hire orientation and ongoing department education

Benefits

• Healthcare that fits your needs
• 401(k) with Employer Match
• Generous Paid Time Off
• Wellness. - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered
• Learning & Development. - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional