Healthcare Pricing Specialist
Job Summary
To support the Payment Integrity Operations team, the full-time Pricing Resolution Specialist II will accurately review, analyze, and reprice healthcare claims across various reimbursement methodologies while working remotely or onsite as needed.
Key Responsibilities
- Review and validate medical claims and supporting documentation to determine appropriate pricing actions
- Investigate claim status questions and resolve pricing discrepancies through established procedures
- Document pricing determinations and maintain records to support audit readiness and operational transparency
Required Qualifications
- High school diploma or equivalent
- Minimum of 2 years of experience in healthcare claims, reimbursement, or payment integrity
- Experience with healthcare claims adjudication or pricing systems
- Working knowledge of CMS reimbursement methodologies and payer-provider contract language
- Proficiency with Microsoft Office applications, including Outlook, Word, and Excel
Complete Job Description
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