Hybrid Medicare Pricing Analyst | CMS Updates & Claims

WPS—A health solutions company; Georgia; Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote and hybrid work options

Performance bonus and merit increase

401(k) with company match

Job summary

WPS, a health solutions company, is seeking a Medicare Pricing Analyst to research complex pricing and reimbursement issues, validate CMS updates, and maintain pricing information across systems. You will work with CMS and MACs to ensure accurate claims payment and support pricing-related projects.

The role requires a Bachelor’s in Health System Information or equivalent, 1+ year in Medicare pricing/claims, and strong analytical skills.

Qualifications

• Bachelor’s degree in Health System Information or related discipline, or equivalent education/experience.
• 1+ year of Medicare Part A and Part B claims processing experience.
• Knowledge of Medicare program and operations, claims processing and billing procedures.
• Proficient in navigating systems to download/install CMS pricing files (FISS/MCS).
• Strong analytical and problem-solving skills.
• Organizational skills to document Change Requests and pricing TDls.

Responsibilities

• Implement changes to CMS systems, validate updates, and ensure system accuracy.
• Review Medicare Part A/B claims and apply processing guidelines and pricing rules.
• Research pricing information from Redbook, system files, and CMS resources.
• Respond to interdepartmental requests regarding CMS pricing.
• Maintain records of CMS changes and test pricing systems for discrepancies.
• Collaborate with CMS and Shared System Maintainers to implement system changes.

Skills

Analytical skills

Problem solving

Organizational skills

Collaborative teamwork

Education

Bachelor’s degree in Health System Information

Tools

FISS/MCS pricing files

Job description

WPS, a health solutions company, is seeking a Medicare Pricing Analyst to research complex pricing and reimbursement issues, validate CMS updates, and maintain pricing information across systems. You will work with CMS and MACs to ensure accurate claims payment and support pricing-related projects.

The role requires a Bachelor’s in Health System Information or equivalent, 1+ year in Medicare pricing/claims, and strong analytical skills.