Pricing Resolution Specialist

MedReview

Virtual, NY

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JOB DETAILS

JOB TYPE

Full-time

SKILLS

Adjudication, Adjudication Systems, Analysis Skills, Billing, Claims Processing, Code Reviews, Communication Skills, Content Management Systems (CMS), Diagnosis-Related Group (DRG), Documentation, Establish Priorities, Healthcare, High School Diploma, Insurance Claims, Mathematics, Medicaid, Medical Billing, Medical Records, Medical Terminology, Medicare, Microsoft Excel, Microsoft Outlook, Microsoft Word, Multitasking, Organizational Skills, Patient Care, Pricing, Pricing Software, Problem Solving Skills, Quality Assurance, Reimbursement

LOCATION

Virtual, NY

POSTED

30+ days ago

Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier, and Readmission reviews.
Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures. Provide support to various departments related to claim status, claim adjudication questions, and any basic questions related to the adjudication of an inpatient medical claim.

Responsibilities:
This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of MedReview Operations in general.

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.

Qualifications:

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

Salary: $26.50- 30.00 per hour

About the Company

MedReview

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