Medicare Pricing Analyst

WPS Health Solutions; Green Bay (WI); Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) match

Paid time off

Health and dental insurance

Telehealth

Development programs

Additional benefits info

Job summary

WPS Health Solutions, based in Madison, WI, seeks a Medicare Pricing Analyst to research complex pricing and reimbursement issues and ensure claims processing accuracy. You will support CMS pricing updates and collaborate with CMS and MACs to validate pricing data.

The role requires a Bachelor’s degree in Health System Information or related field and at least 1 year of Medicare Part A/B claims experience, with strong analytical and documentation skills.

Qualifications

• Bachelor's degree in Health System Information or a related discipline or equivalent experience.
• 1+ years of Medicare Part A and Part B claims processing experience.
• Knowledge of Medicare program, operations, and claims processing/billing procedures.
• Proficient in downloading/installing files using CMS/FISS/MCS systems.
• Strong analytical and problem-solving skills.
• Demonstrated organizational skills for Change Requests and TDLs pricing documentation.
• Ability to collaborate with the Technical Claims team on projects.

Responsibilities

• Implement changes to CMS systems, including requesting, validating, testing, and validating CMS update files.
• Review Medicare Part A and Part B claims, determine proper processing and pricing from CMS resources.
• Address Requests for Assistance via OnBase with CMS pricing information.
• Review Fee Schedule Disclosures and pricing articles for CMS guideline compliance.
• Maintain up-to-date CMS changes and validate pricing systems with testing.

Skills

Analytical skills

Problem solving

Organizational skills

Documentation

Collaboration

Education

Bachelor's degree in Health System Information or related discipline

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.

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.

Remote Work 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.