Remote opportunity at
MedReviewPricing Resolution Specialist II
MedReview is hiring a Pricing Resolution Specialist II for its Payment Integrity Operations group. The company helps national and regional payers, administrators and other care organizations…
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About This Role
MedReview is hiring a Pricing Resolution Specialist II for its Payment Integrity Operations group. The company helps national and regional payers, administrators and other care organizations improve payment accuracy and cut administrative waste. It has worked in this area for more than four decades. The specialist reviews and reprices healthcare claims across Medicare, Medicaid and commercial business. Pricing decisions rely on CMS reimbursement rules, payer contract terms, client-specific requirements and…
Job Description
MedReview is hiring a Pricing Resolution Specialist II for its Payment Integrity Operations group. The company helps national and regional payers, administrators and other care organizations improve payment accuracy and cut administrative waste. It has worked in this area for more than four decades.
The specialist reviews and reprices healthcare claims across Medicare, Medicaid and commercial business. Pricing decisions rely on CMS reimbursement rules, payer contract terms, client-specific requirements and internal guidelines. Work covers inpatient, outpatient, professional and UB claims, plus claim status questions and pricing variances. Every determination must be documented clearly enough to survive audit and client scrutiny. The specialist also coordinates with operations and client services and takes part in training and improvement projects.
Applicants need at least two years in payment integrity, pricing, reimbursement or claim adjudication work in healthcare, plus hands-on time in platforms like Facets, Cosmos, CAS, PSI or an encoder tool. Practical knowledge of CMS methods and of Medicare, Medicaid and commercial reimbursement is expected, along with an understanding of payer contracts and basic medical terminology and HIPAA rules. A high school diploma or equivalent is the education requirement. The role is full time and can be remote or in-office, depending on need. Remote workers must maintain a private, secure workspace that protects PHI. Pay is $27.00 to $30.00 per hour based on experience, and periodic late shifts may be needed.
Responsibilities
- Examine medical claims, forms, adjudication records and supporting paperwork to verify data and select the correct pricing step.
- Use CMS methodology, payer contracts and client rules to calculate allowable reimbursement.
- Handle Medicare, Medicaid and commercial claims across inpatient, outpatient, professional and UB types.
- Look into status questions, pricing gaps and reimbursement problems, escalating when necessary.
- Record each pricing rationale so it stands up to audit and client review.
- Contribute to special projects, process improvements and training.
Requirements
- Minimum two years in claims, adjudication, reimbursement, pricing or payment integrity.
- Experience with Facets, Cosmos, CAS, PSI or encoder platforms.
- Working understanding of CMS methods and Medicare, Medicaid and commercial principles.
- Familiarity with how payer agreements are worded and structured for reimbursement.
- Basic medical terminology and HIPAA privacy awareness.
- Analytical reasoning, precision and clear written and verbal communication.
- Proficient in Outlook, Word and Excel, and able to work independently across deadlines.
- For remote work: fast internet (300 Mbps suggested) and a dedicated, secure room.
Qualifications
- Background across UB, professional and facility claim types.
- Experience in payment integrity, claims auditing or reimbursement operations.
- Contract interpretation and reimbursement analysis know-how.
- Work with health plans, TPAs or payment integrity firms.
Core Skills
Benefits
- Health, dental and eye coverage.
- Retirement plan (401(k)) with matching contributions.
- Vacation days plus company holidays.
- Flexible spending accounts and commuter benefits.
- Learning opportunities, including LinkedIn Learning and ongoing training.
- Wellness programs.
Frequently Asked Questions
Answers are based only on the employer’s listing; where it doesn’t say, neither do we.
Can this role be remote?
Yes. The job may be remote or in the office, depending on operations.
What is the pay?
$27.00 to $30.00 per hour, based on experience.
Are late shifts involved?
Late-shift rotations come up now and then, and flexible scheduling may be offered.
What experience is needed?
At least two years in healthcare claims, adjudication, reimbursement, pricing or payment integrity.
Sample Interview Questions
AI-generated questions tailored to this specific role — a preview of the full practice set.