Lead Medical Pricing & Network Strategy

Judi Health; Charlotte (NC); Hybrid; USD 107,000 - 134,000; Full time

Job summary

Judi Health in New York, NY is seeking a Lead, Medical Network Pricer to serve as the pricing SME for medical claim pricing within a tech-enabled healthcare platform. The role interprets contract and provider reimbursement terms and applies multiple pricing methodologies to complex claims.

You will document pricing rules, validate reimbursement data, and partner with Product and Engineering to scale automation. Hybrid work options available in NYC, Denver, or Charlotte.

Qualifications

• Bachelor’s degree in finance, economics, business, healthcare administration, data analytics, mathematics, information systems, or a related field required.
• Seven or more years of progressive experience in medical claim pricing, provider reimbursement, or related function.
• Subject matter expertise in Medicare-based reimbursement, Reference-Based Pricing, and professional/institutional pricing.
• Advanced knowledge of procedure, revenue, diagnosis, and modifier logic; pricing methodologies.
• Experience with data sets, fee schedules, code mappings, and rate tables for system ingestion.
• Ability to convert pricing workflows into business rules and technical requirements for Product and Engineering.
• Proven ability to explain complex reimbursement calculations with clear documentation.

Responsibilities

• Interprets complex provider contracts and translates pricing terms into rules for engineering.
• Manually prices complex claims across professional, inpatient, outpatient, and related services.
• Applies Medicare-based pricing, RBP, fee schedules, and other reimbursement methods.
• Maintains pricing rules, data dependencies, assumptions, and decision criteria.
• Leads pricing support for new client implementations and platform updates.
• Establishes quality controls and audit trails for pricing accuracy.

Skills

Pricing strategy

Analytical thinking

Communication

Cross-functional collab

Education

Bachelor’s degree in finance/economics/business/healthcare admin/data analytics

Tools

Excel

SQL

BI tools

Pricing platforms

Job description

Judi Health in New York, NY is seeking a Lead, Medical Network Pricer to serve as the pricing SME for medical claim pricing within a tech-enabled healthcare platform. The role interprets contract and provider reimbursement terms and applies multiple pricing methodologies to complex claims.

You will document pricing rules, validate reimbursement data, and partner with Product and Engineering to scale automation. Hybrid work options available in NYC, Denver, or Charlotte.