MedReview Inc. logo
MedReview Inc.

MedReview Inc. helps payors identify inaccurate medical claims to save millions in overpayments.

Pricing Resolution Specialist

Pricing AnalystPricing AnalystFull TimeRemoteSeniorTeam 201-500H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

3 hours ago

Salary

$26 - $30 / hour

Seniority

Senior

High School5 yrs expEnglish

Job Description

Pricing Resolution Specialist

MedReview Inc.

• Responsible for reviewing data in the review application and client claim processing system, and comparing with corresponding UB, medical record or other documentation. • Responsible for reviewing all necessary documentation as necessary to determine appropriate reimbursement for a claim. • Responsible for reviewing adjudication software system’s claim and line items for determination of how to price a claim / line item. • Possess ability to work at a computer for extended periods. • Other duties as assigned.

Job Requirements

  • High School Diploma or Equivalent
  • Minimum of 5 years related work experience.
  • Prior experience with claim adjudication systems, grouping and pricing software, and other claim adjudication and claim pricing systems.
  • Basic knowledge of medical terminology.
  • Good knowledge of Microsoft Word, Excel and Outlook
  • Intermediate mathematics aptitude
  • Basic communication skills
  • Proficient organizational abilities
  • Proficient comprehension capabilities
  • Ability to prioritize multiple tasks
  • Experience with UB/inpatient institutional claims
  • Proficient knowledge of Medicare and Medicaid billing & payment and coverage guidelines
  • Strong experience in the analysis and processing of claims, quality assurance, CMS payment methodologies (i.e., DRGs, Cost Outliers)
  • Must be able to work with minimal supervision
  • Creative thinker with good skills at problem resolution specifically related to healthcare claim adjudication.

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