Job Opportunities API

About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health . Location: Hybrid (at least 3 days per week in our NYC, Denver, or Charlotte offices) Position Summary The Lead, Medical Network Pricer serves as the subject matter expert for medical claim pricing within a technology-enabled healthcare environment. The Medical Network Pricer interprets contract and provider reimbursement terms and has a command of various provider reimbursement methodologies. This role can then apply these terms to claims data, considering the application of coding requirements, fee schedules, payment and reimbursement policies. This role can define and document pricing rules; prepares, validates, and maintains reimbursement data sets for Judi ingestion; and resolves claims requiring exception handling. The role can manually price professional, facility, ancillary, anesthesia, dialysis, behavioral health, laboratory, durable medical equipment, and other medical claims using industry-standard reimbursement methodologies, including Medicare-based pricing and Reference-Based Pricing (RBP). In partnership with Product and Engineering, the role translates manual pricing logic, decision points, and operational controls into requirements for scalable, automated platform capabilities. The role operates with substantial autonomy and is accountable for accurate, consistent, auditable pricing outcomes affecting clients, providers, members, and enterprise financial results. Position Responsibilities: Medical Network Pricing Strategy & Execution Interprets complex provider contract language, reimbursement terms and methods and translates to pricing rules that can be consumed by engineering team. Has a deep understanding of reimbursement and payment policies that govern coding and payment policies. Advises on code sets and tables that must be sourced and maintained for accurate pricing. Manually prices complex professional, inpatient, outpatient, ambulatory surgical center, anesthesia, dialysis, ancillary, behavioral health, laboratory, home health, and durable medical equipment claims in accordance with client requirements and approved reimbursement methodologies. Apply Medicare-based pricing, Reference-Based Pricing (RBP), fee schedules, resource-based relative value methodologies, diagnosis-related groups, ambulatory payment classifications, per-diem rates, case rates, percent-of-charge arrangements, stop-loss provisions, and other approved reimbursement approaches. Research and determine appropriate reimbursement when claims contain incomplete, conflicting, unusual, or nonstandard coding, provider, service, or payment information. Define, document, validate, and maintain pricing rules, calculation steps, data dependencies, assumptions, and decision criteria used to produce consistent and reproducible claim outcomes. Lead pricing support for new client implementations, reimbursement programs, fee-schedule updates, claim types, migrations, and platform enhancements. Establish quality reviews, approval controls, and monitoring routines that protect manual and automated claim-pricing accuracy a