Pricing Resolution Specialist II - Remote Claims Expert

MedReview Inc.; New York (NY); Remote; USD 37,000 - 41,000; Full time

Benefits offered by this job

Medical coverage

401(k) match

PTO & Holidays

Flexible spending accounts

Professional development

LinkedIn Learning

Job summary

MedReview Inc. seeks a Pricing Resolution Specialist II to review and reprice healthcare claims across Medicare, Medicaid, and Commercial lines. You will apply CMS policies, payer-provider contracts, and internal guidelines to ensure accurate pricing determinations.

The role can be remote or in-office based on needs, with a PHI-secure workspace and full-time hours. Strong analytical skills and healthcare claims knowledge are essential.

Qualifications

• Knowledge of healthcare claims pricing and reimbursement required.
• Strong analytical and communication skills.
• Experience with CMS reimbursement methodologies a plus.

Responsibilities

• Review claims, adjudication records, and supporting documentation to validate pricing.
• Apply CMS reimbursement methods and contract terms to determine pricing.
• Analyze Medicare, Medicaid, and Commercial claims for pricing.
• Document pricing determinations and support audit readiness.

Skills

Healthcare claims knowledge

Analytical problem solving

MS Office

Education

High school diploma or equivalent

Tools

Facets

Cosmos

CAS

PSI

Encoder

Job description

MedReview Inc. seeks a Pricing Resolution Specialist II to review and reprice healthcare claims across Medicare, Medicaid, and Commercial lines. You will apply CMS policies, payer-provider contracts, and internal guidelines to ensure accurate pricing determinations.

The role can be remote or in-office based on needs, with a PHI-secure workspace and full-time hours. Strong analytical skills and healthcare claims knowledge are essential.