Medicare Pricing Analyst: CMS & Claims Specialist

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

Benefits offered by this job

Remote and hybrid work options

Performance bonus

401(k) with company match

Health/dental/telehealth start day 1

Professional development

Job summary

WPS, a health solutions company, is seeking a Medicare Pricing Analyst to research complex pricing and reimbursement issues and validate CMS pricing updates. You will support CMS collaborations, ensure accurate pricing in Medicare systems, and assist with system testing and documentation.

The role requires a Bachelor’s degree and 1+ year of Medicare Part A/B claims processing experience, with strong analytical and organizational skills.

Qualifications

• Bachelor’s degree 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 billing procedures.
• Proficient in navigating systems to download and install pricing files (FISS/MCS).
• Strong analytical and problem-solving skills.
• Ability to coordinate documentation for Change Requests and TDLs.

Responsibilities

• Implement CMS system changes, validate updates, and test CMS releases.
• Review Part A/Part B claims for proper payment rules and pricing.
• Respond to pricing-related inquiries using CMS and Shared System Maintainers resources.
• Assess Fee Schedule disclosures and pricing articles for CMS guideline compliance.
• Maintain thorough records of CMS changes and perform system validation.

Skills

Analytical skills

Problem-solving

Organizational skills

Collaboration

Education

Bachelor’s degree in Health System Information or related field

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 and validate CMS pricing updates. You will support CMS collaborations, ensure accurate pricing in Medicare systems, and assist with system testing and documentation.

The role requires a Bachelor’s degree and 1+ year of Medicare Part A/B claims processing experience, with strong analytical and organizational skills.