Senior Medical Network Pricing Lead

Transformcap; United States; Hybrid; USD 120,000 - 160,000; Full time

Job summary

Judi Health seeks a Lead, Medical Network Pricer to serve as the subject matter expert for medical claim pricing within a technology-enabled healthcare environment. You will interpret contract terms, apply reimbursement methodologies, and draft pricing rules for scalable platform capabilities.

You will partner with Product and Engineering to translate manual pricing logic into automated requirements, ensuring accurate and auditable outcomes for diverse claim types across multiple clients and

Qualifications

• Bachelor's degree in finance, economics, healthcare administration, or related field.
• 7+ years of progressive experience in medical claim pricing or related function.
• Subject matter expertise in Medicare-based reimbursement and pricing methodologies.
• Advanced knowledge of procedure, revenue, diagnosis, and modifier logic; physician fee schedules.

Responsibilities

• Interpret provider contracts and reimbursement terms to pricing rules for engineering consumption.
• Manually price complex claims using standard reimbursement methodologies.
• Define, document, validate, and maintain pricing rules and data dependencies.
• Lead pricing support for client implementations and platform enhancements.
• Establish quality checks and monitoring routines for pricing accuracy.

Skills

Pricing strategy

Pricing rules drafting

Data analysis

Communication

Problem solving

Education

Bachelor's degree in finance or related field

Tools

Excel

SQL

BI tools

Job description

Judi Health seeks a Lead, Medical Network Pricer to serve as the subject matter expert for medical claim pricing within a technology-enabled healthcare environment. You will interpret contract terms, apply reimbursement methodologies, and draft pricing rules for scalable platform capabilities.

You will partner with Product and Engineering to translate manual pricing logic into automated requirements, ensuring accurate and auditable outcomes for diverse claim types across multiple clients and