Medicare Pricing Analyst

WPS Data Logistics, Inc.; Madison, Northern (WI, KY); Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

401(k) with company match

Health insurance

Dental insurance

Telehealth services

Paid time off

Job summary

WPS Data Logistics, Inc. in Madison, WI is seeking a Medicare Pricing Analyst to research complex Medicare pricing and reimbursement issues, ensuring accuracy in Medicare claims processing and coding guidelines.

The role supports CMS pricing updates, maintains pricing data, and collaborates with CMS, Shared System Maintainers, and MACs for timely claims payments. The position also reviews CMS pricing guidance, assists with testing and validation, maintains internal documentation, and supports

Qualifications

• Bachelor’s degree in Health System Information or related field.
• 1+ years of Medicare Part A/B claims processing experience.
• Knowledge of Medicare program operations and billing procedures.
• Proficient in downloading/installing CMS files (FISS/MCS).
• Strong analytical and problem-solving skills.
• Experience documenting Change Requests and related pricing TDLs.

Responsibilities

• Investigate CMS pricing changes and validate updates.
• Review Part A/B claims, pricing files, and release notes for accuracy.
• Respond to internal requests with CMS-related pricing guidance.
• Monitor pricing disclosures and CMS articles for compliance.
• Document CMS changes and perform regular testing of pricing systems.
• Collaborate with CMS and Shared System Maintainers to implement system changes.

Skills

Medicare pricing & billing

Medicare Part A & B processing

Analytical thinking

Documentation & change requests

Education

Bachelor’s degree in Health System Information

Tools

FISS/MCS pricing files

Job description

Corporate Center
1717 W Broadway
Madison, WI 53713, USA

Corporate Center
1717 W Broadway
Madison, WI 53713, USA

Role Snapshot The Medicare Pricing Analystis responsible forresearching 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,maintainspricing information within Medicare systems, and collaborates with CMS, Shared System Maintainers, and other Medicare Administrative Contractors (MACs) to ensureaccurateandtimelyclaims payment.

The Medicare Pricing Procedures Analyst also researches and responds to interdepartmental requests, reviews Medicare pricing guidance, supports system testing and validation,maintainsinternal documentation, andassiststhe Technical Claims team with projects that improve the accuracy and efficiency of Medicare pricing operations. SalaryRange 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 expectedto workhybrid,2 days a weekonsiteon 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 youenjoy the following:

• Implementrequiredchanges 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 provideaccurateresponses 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 andvalidatesystem changes, troubleshoot issues, and support the enhancement of pricing systems and processes.

Minimum Qualifications

• Bachelor’s degree in Health System Informationor a related discipline, or equivalent combination of education and experience.
• 1 or more years of experienceinMedicare Part A and Part Bclaimsprocessing.
• 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 skillsand problem-solving skills.
• Demonstratedorganizational skills withability to coordinate andmaintaindetailed documentation for the implementation of Change Requests and TDLs related to pricing.
• Ability to collaborate effectively and provide support to the Technical Claimsteamwith various projects and assignments as needed.

Preferred Qualifications

• Experience performingyearly Profile Builds related to pricing functions in MCS and FISSpreferred.
• 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 ).
• 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% vestedimmediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs

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,seniorsand 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-dutyand retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we servefor nearly 80 years . Proud to be military and veteran ready.

Culture Drives Our Success

WPS’ culture is where thegreat workand innovations of our people are seen,fueledand rewarded. Weaccomplishthis by creating an open and empowering employee experience. We recognize the benefits ofemployee engagement as an investment in our workforce—both current and future—to effectivelyseek,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.

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

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Education

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Licenses & Certifications

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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