Pricing Resolution Processor

Job Summary

To support the Payment Integrity Operations team, the full-time remote Pricing Resolution Processor II will review, group, and price healthcare facility claims to identify overpayments and ensure reimbursement accuracy while adhering to client-specific methodologies and regulatory guidelines.

Key Responsibilities

• Review and validate healthcare claims for completeness and accuracy before pricing
• Group facility claims using established methodologies and apply reimbursement standards
• Ensure compliance with payer contract requirements and maintain documentation supporting pricing determinations

Required Qualifications

• High school diploma or equivalent
• 1-3 years of experience in healthcare claims processing or related operations
• Working knowledge of ICD-10 coding, CPT coding, and medical terminology
• Strong analytical skills and ability to navigate multiple systems simultaneously
• Proficiency in Microsoft Office applications, particularly Excel and Word