Senior Medical Pricing Architect (Hybrid)

Judi Health, LLC; New York (NY); Hybrid; USD 128,000 - 160,000; Full time

Job summary

Judi Health is seeking a Lead, Medical Network Pricer to serve as the pricing SME for medical claims in a technology-enabled environment. You will interpret contracts, apply Medicare-based pricing, and drive pricing automation in collaboration with Product and Engineering.

The role requires deep knowledge of reimbursement methodologies, manual pricing across diverse claim types, and leadership in new client implementations and data governance.

Qualifications

• Bachelor's degree and 7+ years in medical claim pricing or related field.
• Advanced knowledge of reimbursement methods and coding logic.
• Ability to translate pricing rules into technical requirements.

Responsibilities

• Interpret complex provider contracts to define pricing rules for claims.
• Manual pricing across professional and facility claims per approved methodologies.
• Lead pricing automation efforts with Product and Engineering.

Skills

Medicare-based pricing

Reference-Based Pricing

Excel

SQL

Pricing rules

Education

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

Tools

SQL

BI tools

Pricing software

Job description

Judi Health is seeking a Lead, Medical Network Pricer to serve as the pricing SME for medical claims in a technology-enabled environment. You will interpret contracts, apply Medicare-based pricing, and drive pricing automation in collaboration with Product and Engineering.

The role requires deep knowledge of reimbursement methodologies, manual pricing across diverse claim types, and leadership in new client implementations and data governance.