Pricing Resolution Specialist
MedReview Inc.New York, New York, United States
Posted March 6, 2026
Full Time
About the Company
MedReview Inc., a physician-led payment integrity company, specializes in thorough claim reviews and audits to ensure accurate billing. Leveraging advanced algorithms enriched by machine learning and clinical data, MedReview offers comprehensive services including DRG validations, hospital bill audits, and quality management, resulting in significant savings for clients while maintaining the lowest appeal overturn rate in the industry.
Job Description
Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures.
Requirements
- 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
Benefits
- Generous Paid Time Off
- 401k Matching
- Retirement Plan
