MedReview is hiring a
Team Lead, Inpatient Claims Pricing Specialist, Remote - Worldwide
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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
This job is filled or no longer available