Pricing Resolution Specialist

MedReview Inc.

Pricing Resolution Specialist reviewing inpatient medical claims data and processing at MedReview. Ensuring accurate reimbursements and resolving adjudication inquiries.

Posted 6/25/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $27 - $30 per hourWebsite

About the role

Key responsibilities & impact

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.

Requirements

What you’ll need

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.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account MedReview Inc. Website LinkedIn All Job Openings 201 - 500 employees ⚕️ Healthcare Insurance 💸 Finance Healthcare Insurance
Finance MedReview Inc. is a leading provider of advanced payment integrity solutions, specializing in healthcare claims. They work with a wide range of clients, including health plans, government agencies, and payors, to reduce unnecessary waste and save billions of dollars. Their team of highly trained physicians, registered nurses, and certified coders conduct thorough clinical and coding reviews to identify inaccuracies in healthcare claims. MedReview employs proprietary algorithms to analyze complex data and detect suspicious payment trends, offering a unique blend of clinical expertise and advanced technology to maximize efficiencies and improve healthcare cost management. Pricing Resolution Specialist Job not on LinkedIn 🔥 1 minute ago 🇺🇸 United States – Remote 💵 $26 - $30 / hour ⏰ Full Time 🟡 Mid-level 🟠 Senior 💰 Pricing Analyst Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
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. 🎯 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. Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Pricing Manager 🔥 12 hours ago Kilpatrick Townsend & Stockton LLP 1001 - 5000 🤝 B2B 📋 Compliance Website LinkedIn All Job Openings Manager, Pricing in Atlanta office of Kilpatrick law firm, supporting pricing strategy and financial analysis. Collaborates with legal professionals to develop pricing solutions for clients. 🇺🇸 United States – Remote 💵 $150k - $165k / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 💰 Pricing Analyst Senior Product Manager – Dynamic Pricing, Parking Technology 🔥 14 hours ago IDeaS Revenue Solutions 501 - 1000 ☁️ SaaS Website LinkedIn All Job Openings Product Manager overseeing analytics software development at IDeaS. Collaborating with teams and translating customer needs into technical requirements. 🇺🇸 United States – Remote ⏰ Full Time 🟠 Senior 💰 Pricing Analyst Associate Director, Channel & Pricing Strategy 🔥 16 hours ago Novartis 10,000+ employees 💊 Pharmaceuticals 🧬 Biotechnology ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Associate Director overseeing channel and pricing strategies for Novartis, enhancing customer satisfaction and business solutions. Collaborating cross-functionally for optimal pricing and contracting strategies. 🇺🇸 United States – Remote 💵 $160.3k - $297.7k / year ⏰ Full Time 🟠 Senior 💰 Pricing Analyst 🦅 H1B Visa Sponsor Senior Pricing Analyst 🕒 Yesterday Nava 501 - 1000 🏛️ Government ☁️ SaaS 🌍 Social Impact Website LinkedIn All Job Openings Senior Pricing Analyst developing cost proposals and strategies for federal and state government contracts. Collaborating with cross-functional teams to enhance competitiveness and compliance. 🇺🇸 United States – Remote 💵 $110k - $125k / year ⏰ Full Time 🟠 Senior 💰 Pricing Analyst 🦅 H1B Visa Sponsor Senior Software Pricing Analyst 🕒 5 days ago SAS 10,000+ employees 🤖 Artificial Intelligence 🤝 B2B ☁️ SaaS Website LinkedIn All Job Openings Senior Software Pricing Analyst managing pricing and monetization strategies for SAS product portfolio. Collaborating with cross-functional teams and leveraging analytical tools for pricing strategy execution. 🇺🇸 United States – Remote 💰 Grant on 2022-11 ⏰ Full Time 🟠 Senior 💰 Pricing Analyst 🦅 H1B Visa Sponsor View More Pricing Analyst Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Applicant Tracking System Keywords

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Hard Skills & Tools

claim adjudication systemsgrouping softwarepricing softwaremedical terminologyMicrosoft WordMicrosoft ExcelMicrosoft Outlookmathematics aptitudeanalysis of claimsCMS payment methodologies

Soft Skills

communication skillsorganizational abilitiescomprehension capabilitiesprioritizationproblem resolutioncreativityability to work independentlyattention to detailtime managementadaptability

Certifications

High School Diploma or Equivalent