Remote Pricing Resolution Specialist II

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

Job summary

MedReview is seeking a Pricing Resolution Processor II for its Remote Operations team. The role focuses on reviewing, grouping, and pricing healthcare facility claims to ensure reimbursement accuracy and detect potential overpayments.

The candidate will apply client-specific methodologies, regulatory guidance, and internal standards while maintaining productivity and quality in a high-volume environment. Strong attention to PHI, HIPAA compliance, and data quality is essential.

Qualifications

• Must have high school diploma or equivalent and 1–3 years in healthcare claims processing.
• Strong knowledge of ICD-10 coding, CPT coding, and revenue codes.
• Excellent analytical, problem solving, and data validation skills.
• Ability to learn multiple systems and maintain data accuracy.
• Excellent written and verbal communication abilities.

Responsibilities

• Review claims for completeness, accuracy, and eligibility.
• Validate information before pricing activity begins.
• Group facility claims according to client/internal methodologies.
• Apply payer specific reimbursement methodologies and contractual terms.
• Identify pricing discrepancies and resolve issues promptly.
• Maintain documentation supporting pricing decisions and processing activities.
• Support process improvement and collaboration across teams.

Skills

Analytical skills

Attention to detail

Microsoft Excel

Communication skills

Independent work

Time management

Education

High school diploma or equivalent

Healthcare claims processing knowledge

ICD-10/CPT coding knowledge

PHI/HIPAA awareness

Tools

Microsoft Office Suite

Claims processing systems

Job description

MedReview is seeking a Pricing Resolution Processor II for its Remote Operations team. The role focuses on reviewing, grouping, and pricing healthcare facility claims to ensure reimbursement accuracy and detect potential overpayments.

The candidate will apply client-specific methodologies, regulatory guidance, and internal standards while maintaining productivity and quality in a high-volume environment. Strong attention to PHI, HIPAA compliance, and data quality is essential.