High Dollar Review Specialist
Brighton Health Plan Solutions, LLC • Chapel Hill, NC • Posted July 13, 2026
About the Role
About the Role
Brighton Health Plan Solutions is seeking a High Dollar Specialist to review high dollar claims for appropriate and accurate billing, pricing and adjudication. This individual will play a key in the Quality Department and interact with many internal and external stakeholders.
Primary Responsibilities
+ Review high dollar claims to ensure claim was priced and billed correctly including implant and supply charges, observation room charges, units billed for drugs and procedures.
+ Review DRG for accuracy as compared to billed procedures, diagnosis/condition, age, etc.
+ Develop reporting mechanism to track pertinent claims information related to high dollar claims.
+ Collaborate review efforts with CMO, Legal and other departments as needed.
+ Coordinate efforts with external vendors as required.
Essential Qualifications
+ Significant experience in dealing with facility-based...
Brighton Health Plan Solutions is seeking a High Dollar Specialist to review high dollar claims for appropriate and accurate billing, pricing and adjudication. This individual will play a key in the Quality Department and interact with many internal and external stakeholders.
Primary Responsibilities
+ Review high dollar claims to ensure claim was priced and billed correctly including implant and supply charges, observation room charges, units billed for drugs and procedures.
+ Review DRG for accuracy as compared to billed procedures, diagnosis/condition, age, etc.
+ Develop reporting mechanism to track pertinent claims information related to high dollar claims.
+ Collaborate review efforts with CMO, Legal and other departments as needed.
+ Coordinate efforts with external vendors as required.
Essential Qualifications
+ Significant experience in dealing with facility-based...