Medicare Pricing Analyst (Hybrid/Remote)

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

Job summary

WPS Health Solutions is seeking a Medicare Pricing Analyst to research complex pricing and reimbursement issues, ensuring accuracy in CMS pricing updates and claims processing. The role interfaces with CMS, Shared System Maintainers, and MACs to validate changes and maintain pricing information.

The position supports testing, documentation, and interdepartmental requests while contributing to the efficiency of pricing operations. A background in Medicare Part A/B claims processing is preferred.

Qualifications

• Bachelor's degree in Health System Information or 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 to 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 Change Requests and pricing.
• Ability to collaborate with the Technical Claims team on various projects as needed.

Responsibilities

• Implement changes and enhancements to CMS systems, including requesting, validating, and performing maintenance, coding, testing, and validation.
• Review Medicare Part A and Part B claims to ensure proper application of processing guidelines and pricing.
• Respond to requests via OnBase and provide pricing research using CMS resources.
• Review and provide feedback on Fee Schedule Disclosures and pricing articles for CMS guidelines and internal procedures.
• Maintain records of CMS-related changes and perform regular testing to address discrepancies.
• Collaborate with CMS and Shared System Maintainers to implement system changes and support pricing improvements.

Skills

Analytical skills

Problem-solving skills

Collaboration

Documentation

Education

Bachelor's degree in Health System Information or related discipline

Equivalent combination of education and experience

Job description

WPS Health Solutions is seeking a Medicare Pricing Analyst to research complex pricing and reimbursement issues, ensuring accuracy in CMS pricing updates and claims processing. The role interfaces with CMS, Shared System Maintainers, and MACs to validate changes and maintain pricing information.

The position supports testing, documentation, and interdepartmental requests while contributing to the efficiency of pricing operations. A background in Medicare Part A/B claims processing is preferred.