Medicare Pricing Analyst

WPS Health Solutions; Denver (CO); Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote and hybrid work options

Performance bonus

401(k) match

Job summary

WPS Health Solutions in Madison, Wisconsin, seeks a Medicare Pricing Analyst to research complex Medicare pricing, support CMS updates, and ensure accurate claims processing and coding guidelines. You will collaborate with CMS, Shared System Maintainers, and MACs to validate and implement pricing changes.

Remote/hybrid options are available. Base pay ranges from 45,000 to 56,000 USD, with benefits and professional development opportunities.

Qualifications

• Bachelor's degree in Health System Information or related discipline, or equivalent combination of education and experience.
• 1+ years of experience in Medicare Part A and Part B claims processing.
• Knowledge of Medicare program and operations, and understanding of claims processing and billing procedures.
• Proficiency in navigating systems to download/install CMS pricing files (FISS/MCS).
• Strong analytical and problem-solving skills.
• Ability to coordinate documentation for Change Requests/TDLs related to pricing.

Responsibilities

• Research and respond to pricing inquiries using CMS and Shared System Maintainers resources.
• Review Medicare Part A/B claims to ensure proper processing and pricing.
• Implement, validate, and test CMS pricing updates and changes.
• Maintain detailed internal documentation of CMS-related changes.
• Collaborate with CMS and Shared System Maintainers to troubleshoot pricing system issues.

Skills

Medicare pricing

Claims processing

Analytical skills

Documentation

Collaboration

Education

Bachelor's degree in Health System Information

Tools

FISS/MCS pricing files

Job description

Role Snapshot

The Medicare Pricing Analyst is responsible for researching complex Medicare pricing and reimbursement issues while ensuring the accuracy and effectiveness of Medicare claims processing and coding guidelines. This role supports the implementation and validation of CMS pricing updates, maintains pricing information within Medicare systems, and collaborates with CMS, Shared System Maintainers, and other Medicare Administrative Contractors (MACs) to ensure accurate and timely claims payment.

The Medicare Pricing Procedures Analyst also researches and responds to interdepartmental requests, reviews Medicare pricing guidance, supports system testing and validation, maintains internal documentation, and assists the Technical Claims team with projects that improve the accuracy and efficiency of Medicare pricing operations.

Salary Range

45,000-56,000

The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Work Location

Employees within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713) will be expected to work hybrid, 2 days a week onsite on a regular basis.

We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin (more than 45 miles from Madison).

How do I know this opportunity is right for me? If you enjoy the following:

• Implement required changes and enhancements to CMS systems, including requesting, validating, and performing maintenance, coding, testing, and validation. Download, verify, and install CMS update files to ensure system accuracy.
• Review Medicare Part A and Part B claims, including complex and specialty claims, to ensure proper application of processing guidelines, payment rules, and manual calculations. Obtain pricing information from Redbook, system files, and CMS resources.
• Address Requests for Assistance received via OnBase, conducting in-depth research to provide accurate responses related to pricing using CMS and Shared System Maintainers' resources.
• Review, analyze, and provide feedback on Fee Schedule Disclosures and pricing articles, ensuring compliance with CMS guidelines and internal procedures.
• Maintain detailed and up-to-date records of all CMS-related changes and updates, and ensure the accuracy of pricing systems, including performing regular testing and validation to address discrepancies.
• Work closely with CMS and Shared System Maintainers to implement and validate system changes, troubleshoot issues, and support the enhancement of pricing systems and processes.

Minimum Qualifications

• Bachelor's degree in Health System Information or a related discipline, or equivalent combination of education and experience.
• 1 or more years of experience in Medicare Part A and Part B claims processing.
• Knowledge of Medicare program and operations, as well as a thorough understanding of claims processing and billing procedures.
• Proficient in navigating systems and/or applications to effectively download and install files (i.e., FISS/MCS pricing files).
• Strong analytical skills and problem-solving skills.
• Demonstrated organizational skills with ability to coordinate and maintain detailed documentation for the implementation of Change Requests and TDLs related to pricing.
• Ability to collaborate effectively and provide support to the Technical Claims team with various projects and assignments as needed.

Preferred Qualifications

• Experience performing yearly Profile Builds related to pricing functions in MCS and FISS preferred.
• Experience with a Medicare Administrative Contractor company.

Remote Work Requirements

• High speed cable or fiber internet.
• Wired (ethernet cable) internet connection from your router to your computer.
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net).
• Please review Remote Worker FAQs for additional information.

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs
• Review additional benefits: (https://www.wpshealthsolutions.com/careers/)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

Medicare (GHA)

This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.