Healthcare Pricing Specialist

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