Medreview is Hiring a Pricing Resolution Specialist Near New York, NY
Position SummaryAt 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. Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures. Provide support to various departments related to claim status, claim adjudication questions, and any basic questions related to the adjudication of an inpatient medical claim. Responsibilities:This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of MedReview Operations in general.
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 Outliers)
Must be able to work with minimal supervision
Creative thinker with good skills at problem resolution specifically related to healthcare claim adjudication
Salary: $26.50- 30.00 per hour Powered by JazzHR dkfUzKX8VC