Senior Medical Network Pricing Lead (Hybrid)

Capital Rx; Denver (CO); Hybride; USD 106 000 - 160 000; Plein temps

Résumé du poste

Judi Health, a health-tech leader, invites a Lead, Medical Network Pricer to join our hybrid team with offices in New York, Denver, and Charlotte. You will interpret complex provider contracts and apply reimbursement methodologies to pricing, directly influencing client outcomes and financial integrity.

The role requires 7+ years in medical pricing, Medicare-based reimbursement expertise, and strong Excel/SQL/data analytics capabilities.

Qualifications

• Bachelor’s degree in a related field required.
• 7+ years in medical claim pricing or related function.
• Expertise in Medicare-based reimbursement and Reference-Based Pricing.
• Strong Excel, SQL, and data analytics skills.

Responsabilités

• Interpret complex provider contracts into pricing rules.
• Manually price diverse claim types per client requirements.
• Develop pricing rules, data dependencies, and decision criteria.
• Lead pricing automation and validation with Product and Engineering.
• Provide pricing compliance and audits.

Connaissances

Analytical skills

Pricing knowledge

Communication

Formation

Bachelor's degree in finance, economics, business, healthcare administration, health information management, data analytics, mathematics, information systems, or a related field

Outils

SQL

Excel

BI tools

Pricing platforms

Description du poste

Judi Health, a health-tech leader, invites a Lead, Medical Network Pricer to join our hybrid team with offices in New York, Denver, and Charlotte. You will interpret complex provider contracts and apply reimbursement methodologies to pricing, directly influencing client outcomes and financial integrity.

The role requires 7+ years in medical pricing, Medicare-based reimbursement expertise, and strong Excel/SQL/data analytics capabilities.