MedReview Inc. helps payors identify inaccurate medical claims to save millions in overpayments.
Pricing Resolution Specialist
Location
United States
Posted
3 hours ago
Salary
$26 - $30 / hour
Seniority
Senior
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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