Remote Pricing Resolution Specialist II

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

Benefits offered by this job

Medical, Dental, and Vision Coverage

401(k) with Employer Match

Paid Time Off and Holidays

FSA and Commuter Benefits

Professional Development Opportunities

LinkedIn Learning Access

Employee Wellness Programs

Collaborative and Mission-Driven Work

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 reimbursement policies and contract terms to ensure accurate pricing.

The position can be remote or in-office based on operational needs, with PHI/HIPAA security requirements and a focus on accuracy, collaboration with internal teams, and process improvements.

Qualifications

• High school diploma or equivalent.
• Minimum of 2 years healthcare claims, adjudication, or related experience.
• Experience with healthcare claims adjudication, pricing, grouping, or encoder systems (Facets, Cosmos, CAS, PSI, Encoder).
• Knowledge of CMS reimbursement methodologies for Medicare, Medicaid, and Commercial claims.
• Understanding of payer-provider contract language and reimbursement structures.
• Strong analytical, problem-solving, and critical-thinking skills.
• High attention to detail and accuracy.
• Strong written and verbal communication skills.
• Basic knowledge of medical terminology and HIPAA/privacy requirements.
• Proficiency with Microsoft Office (Outlook, Word, Excel).
• Ability to work independently while managing multiple priorities and deadlines.

Responsibilities

• Review claims and pricing to determine pricing actions.
• Apply CMS methodologies and contract terms to calculate reimbursement.
• Analyze Medicare, Medicaid, and Commercial claims.
• Review UB claims to ensure pricing accuracy.
• Document pricing determinations clearly.

Skills

Analytical thinking

Problem solving

Attention to detail

Communication skills

Independent work

Education

High school diploma or equivalent

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 reimbursement policies and contract terms to ensure accurate pricing.

The position can be remote or in-office based on operational needs, with PHI/HIPAA security requirements and a focus on accuracy, collaboration with internal teams, and process improvements.