Pricing Resolution Specialist

About the role

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.

Responsibilities

- 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 Outlier) - Must be able to work with minimal supervision - Creative thinker with good skills at problem resolution specifically related to healthcare claim adjudication