Pricing Resolution Processor II (Healthcare Claims)

Location: Remote or office-based depending on operational needs; requires a secure, dedicated workspace and protection of PHI under HIPAA.

Salary: $27.00–$30.00 per hour, commensurate with experience.

Company

hirify.global provides technology-enabled payment integrity solutions for health plans, third-party administrators, and healthcare organizations.

What you will do

• Review healthcare facility claims for completeness, eligibility, accuracy, and supporting documentation.
• Group and price claims using client-specific reimbursement methodologies, payer requirements, and contractual obligations.
• Identify potential overpayments, pricing discrepancies, missing information, and inconsistent claim data.
• Validate data entry, pricing calculations, claim outcomes, and documentation to support accurate determinations.
• Escalate complex reimbursement issues and collaborate with operational teams on workflow efficiency and process improvements.
• Meet productivity, quality, accuracy, and turnaround-time expectations in a high-volume environment.

Requirements

• 1–3 years of experience in healthcare claims processing, billing, reimbursement, revenue cycle, or related healthcare operations.
• High school diploma or equivalent.
• Working knowledge of ICD-10 diagnosis coding, CPT coding, Revenue Codes, medical terminology, and healthcare claims adjudication.
• Strong analytical, problem-solving, organizational, communication, and decision-making skills.
• Proficiency with Microsoft Office applications, including Outlook, Excel, and Word.
• Ability to maintain confidentiality of PHI and comply with HIPAA requirements while working remotely.

Nice to have

• Associate degree in Healthcare Administration, Business Administration, Health Information Management, or a related field.
• Experience with healthcare payment integrity operations, facility claim pricing, payer reimbursement methodologies, or provider contract language.
• Knowledge of Medicare, Medicaid, and commercial healthcare reimbursement principles.

Culture & Benefits

• Full-time position in a fast-paced, production-oriented healthcare operations environment.
• High-speed internet, secure Wi-Fi, and a dedicated workspace are required for remote work.
• Medical, dental, and vision coverage.
• 401(k) with employer match, paid time off, and paid holidays.
• Professional development, continuing education, LinkedIn Learning, training, and wellness programs.