Remote Pricing Resolution Specialist II

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

Benefits offered by this job

Medical Coverage

401(k) Matching

Paid Time Off

FSA & Commuter Benefits

LinkedIn Learning Access

Job summary

MedReview is seeking a Pricing Resolution Processor II to join the Payment Integrity Operations team for remote, full-time work. You will review, group, and price routine healthcare facility claims to identify overpayments and ensure reimbursement accuracy, applying client-specific methodologies and regulatory guidelines.

The ideal candidate has 1–3 years of healthcare claims processing experience, strong analytical skills, and meticulous attention to detail, while maintaining HIPAA compliance

Qualifications

• Required: High school diploma or equivalent.
• 1-3 years in healthcare claims processing, billing or related healthcare operations.
• Knowledge of ICD-10, CPT, Revenue Codes and medical terminology.
• Strong analytical and problem-solving abilities with data-driven decisions.
• Excellent written and verbal communication skills.
• Proficiency with MS Outlook, Excel and Word; ability to navigate multiple systems.

Responsibilities

• Review assigned healthcare claims for accuracy and eligibility.
• Group facility claims using client/internal systems per methodologies.
• Apply reimbursement methodologies per client requirements and regulations.
• Identify pricing discrepancies and potential overpayments.
• Maintain documentation supporting pricing determinations and outcomes.
• Collaborate with internal teams and participate in process improvements.

Skills

Analytical thinking

Problem solving

Communication skills

Independent work

Attention to detail

Education

High School Diploma

Associate degree in Healthcare Administration

Tools

Microsoft Office Suite

Job description

MedReview is seeking a Pricing Resolution Processor II to join the Payment Integrity Operations team for remote, full-time work. You will review, group, and price routine healthcare facility claims to identify overpayments and ensure reimbursement accuracy, applying client-specific methodologies and regulatory guidelines.

The ideal candidate has 1–3 years of healthcare claims processing experience, strong analytical skills, and meticulous attention to detail, while maintaining HIPAA compliance