Medicare Pricing Analyst – Hybrid/Remote

WPS—A health solutions company; North Carolina; On-site; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote/hybrid options available

Performance bonus

401(k) match

Paid time off

Health/dental/telehealth starting day

Development programs

Job summary

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

The role involves maintaining CMS-related documentation, testing pricing systems, and assisting the Technical Claims team on pricing projects.

Qualifications

• Bachelor’s degree in Health System Information or a 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, including claims processing and billing procedures.
• Proficient in navigating systems to download and install files (FISS/MCS pricing files).
• Strong analytical and problem-solving skills.
• Demonstrated organizational skills with ability to document Change Requests and TDLs.
• Ability to collaborate with the Technical Claims team on projects.

Responsibilities

• Research Medicare pricing and CMS updates to ensure accurate pricing and claims processing.
• Review Part A and Part B claims for proper processing rules and manual calculations; obtain pricing from Redbook, systems, and CMS resources.
• Respond to internal requests via OnBase with pricing research and CMS resources.
• Review Fee Schedule Disclosures and pricing articles for CMS guideline compliance.
• Maintain detailed records of CMS changes and perform regular testing of pricing systems.
• Collaborate with CMS and Shared System Maintainers to implement system changes and troubleshoot issues.

Skills

Analytical skills

Problem-solving

Organizational skills

Collaboration

Communication

Education

Bachelor's degree in Health System Information or related discipline

Tools

FISS

MCS pricing files

Job description

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

The role involves maintaining CMS-related documentation, testing pricing systems, and assisting the Technical Claims team on pricing projects.