Pricing Resolution Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Accountable for examining data within the review application and client claim processing system, while comparing it to related UB, medical records, or other relevant documentation.

• Tasked with reviewing all essential documentation required to assess the appropriate reimbursement for a claim.

• Charged with analyzing the adjudication software system’s claims and line items to establish pricing for a claim or line item.

• Must possess the capability to work on a computer for prolonged periods.

• Additional responsibilities as assigned.

⛳️ Requirements

• High School Diploma or Equivalent.

• At least 5 years of relevant work experience.

• Prior experience with claim adjudication systems, grouping and pricing software, as well as other claim adjudication and pricing systems.

• Fundamental knowledge of medical terminology.

• Proficient in Microsoft Word, Excel, and Outlook.

• Intermediate aptitude in mathematics.

• Basic communication skills.

• Strong organizational skills.

• Good comprehension abilities.

• Capability to prioritize various tasks.

• Experience with UB/inpatient institutional claims.

• Solid understanding of Medicare and Medicaid billing, payment, and coverage guidelines.

• Extensive experience in claims analysis and processing, quality assurance, and CMS payment methodologies (e.g., DRGs, Cost Outliers).

• Ability to work independently with minimal supervision.

• Innovative thinker with strong problem-solving skills, particularly in relation to healthcare claim adjudication.

🏝️ Benefits

• Competitive salary.

• Comprehensive health benefits.

• Opportunities for professional development.

• Collaborative work environment.