Remote opportunity at
MedReviewPricing Resolution Processor II
MedReview, a provider of payment integrity solutions partnering with health plans and healthcare organizations for over forty years, seeks a remote Pricing Resolution Processor II for…
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About This Role
MedReview, a provider of payment integrity solutions partnering with health plans and healthcare organizations for over forty years, seeks a remote Pricing Resolution Processor II for its Payment Integrity Operations team. This full-time position centers on evaluating, grouping, and pricing routine facility claims to spot overpayments and verify reimbursement accuracy. The person in this role applies payer specifications, regulatory instructions, contractual agreements, and internal guidelines to execute timely claim pricing…
Job Description
MedReview, a provider of payment integrity solutions partnering with health plans and healthcare organizations for over forty years, seeks a remote Pricing Resolution Processor II for its Payment Integrity Operations team. This full-time position centers on evaluating, grouping, and pricing routine facility claims to spot overpayments and verify reimbursement accuracy.
The person in this role applies payer specifications, regulatory instructions, contractual agreements, and internal guidelines to execute timely claim pricing decisions in a high-volume setting. This position suits an analytical professional with a background in healthcare claims processing who possesses strong attention to detail and can work independently while meeting productivity and quality metrics. Candidates must maintain a secure, private workspace with high-speed internet to protect HIPAA-regulated data and protected health information.
Compensation is set between $27 and $30 per hour based on experience. MedReview provides comprehensive benefits including medical, dental, and vision coverage, a 401(k) plan with an employer match, paid time off, and professional development resources.
Responsibilities
- Examine healthcare claims to check for completeness, accuracy, and eligibility
- Validate claim details and attached documentation prior to initiating pricing work
- Detect missing or inconsistent claim data and perform necessary resolution steps
- Group facility claims using internal and client platforms following established guidelines
- Apply reimbursement methodologies based on payer rules and regulatory standards
- Scan claim information to discover potential overpayments and discrepancies
- Verify data entry and pricing calculations to uphold quality standards
- Record pricing determinations and claim processing actions completely and accurately
- Escalate complex claim problems or reimbursement questions as needed
- Engage in process improvement projects, training events, and team meetings
Requirements
- High school diploma or equivalent
- One to three years of experience in healthcare claims processing, billing, reimbursement, revenue cycle, or related operations
- Working familiarity with ICD-10 diagnosis codes, CPT codes, Revenue Codes, medical terminology, and claim adjudication
- Proficiency with Microsoft Office tools including Outlook, Excel, and Word
- Ability to manage heavy workloads and navigate multiple systems simultaneously while maintaining independence
- High-speed internet connection and a secure, dedicated workspace meeting HIPAA standards
Qualifications
- Associate degree in Healthcare Administration, Business Administration, Health Information Management, or a related field
- Background in healthcare payment integrity operations
- Experience with reviewing and pricing facility claims
- Familiarity with payer reimbursement frameworks and provider contract language
- Previous work with health plans, third-party administrators, or payment integrity organizations
- Understanding of Medicare, Medicaid, and Commercial healthcare reimbursement principles
Core Skills
Benefits
- Comprehensive medical, dental, and vision coverage
- 401(k) retirement plan with an employer match
- Generous paid time off and paid holidays
- Flexible spending accounts and commuter benefits
- Professional development and continuing education opportunities
- Access to LinkedIn Learning and ongoing training programs
- Employee wellness programs
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Is this position remote?
Yes, this is a remote role. Candidates must maintain a secure, dedicated workspace with high-speed internet to protect HIPAA-regulated data.
What is the pay rate for the Pricing Resolution Processor II role?
The compensation ranges from $27 to $30 per hour, determined by the candidate's experience.
What type of employment is this?
This is a full-time position within MedReview's Payment Integrity Operations team.
What experience is required to apply?
Applicants must have a high school diploma or equivalent, alongside one to three years of experience in healthcare claims processing, billing, reimbursement, revenue cycle, or related operations.
Sample Interview Questions
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