Pricing Resolution Specialist II — Remote

MedReview; United States; Remote; USD 37,000 - 41,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) with employer match

Generous paid time off

Flexible spending accounts (FSA)

Commuter benefits

LinkedIn Learning access

Professional development opportunities

Wellness programs

Job summary

MedReview is seeking a Pricing Resolution Specialist II to join our Payment Integrity Operations team. This role reviews, analyzes, and reprices healthcare claims across multiple lines of business, applying CMS policies, contracts, and internal guidelines to ensure accurate pricing.

The position may be remote or in-office based on operational needs. Candidates must maintain PHI security and HIPAA compliance, and work independently to meet deadlines.

Qualifications

• High school diploma or equivalent.
• 2+ years of healthcare claims experience including adjudication, pricing, payment integrity, or related.
• Experience with healthcare claims adjudication or pricing systems (facets, cosmos, CAS, PSI, encoder, etc.).
• Knowledge of CMS reimbursement methodologies and Medicare/Medicaid/Commercial principles.
• Understanding payer-provider contract language and reimbursement structures.
• Strong analytical and communication skills.
• Proficiency with MS Office (Outlook, Word, Excel).

Responsibilities

• Review and price medical claims across multiple lines of business.
• Apply CMS methodologies, contracts, and pricing guidelines to calculate reimbursements.
• Analyze Medicare, Medicaid, and Commercial claims.
• Document pricing determinations and ensure audit-ready records.
• Collaborate with Operations and Client Services to support pricing accuracy.

Skills

Analytical skills

Problem-solving

Critical thinking

Communication

Excel

Education

High school diploma

Tools

Facets

Cosmos

CAS

PSI

Encoder

Job description

MedReview is seeking a Pricing Resolution Specialist II to join our Payment Integrity Operations team. This role reviews, analyzes, and reprices healthcare claims across multiple lines of business, applying CMS policies, contracts, and internal guidelines to ensure accurate pricing.

The position may be remote or in-office based on operational needs. Candidates must maintain PHI security and HIPAA compliance, and work independently to meet deadlines.