Medicare Pricing Analyst - Remote/Hybrid

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

Benefits offered by this job

Remote and hybrid options

Performance bonus

401(k) with match

Job summary

The Medicare Pricing Analyst at WPS—A health solutions company will research and resolve complex CMS pricing and reimbursement issues, ensuring accurate claims processing and pricing updates. You will collaborate with CMS and MACs to validate system changes and respond to internal requests, supporting pricing accuracy across Part A and Part B.

The role emphasizes data integrity, documentation, and cross-team support, with a hybrid work arrangement and opportunities for professional development.

Qualifications

• Bachelor's degree in Health System Information or related discipline or equivalent experience.
• 1+ year of experience in Medicare Part A and Part B claims processing.
• Knowledge of Medicare program and operations, claims processing and billing procedures.
• Proficient in downloading/installing CMS pricing files (FISS/MCS).
• Strong analytical and problem-solving skills.
• Good organizational skills to maintain detailed change documentation.

Responsibilities

• Implement CMS system changes, validate updates, test and install CMS update files.
• Review Part A/B claims and determine proper processing rules and manual calculations.
• Respond to Requests for Assistance via OnBase with CMS pricing resources.
• Review Fee Schedule Disclosures and pricing articles for CMS guidance and internal procedures.
• Maintain up-to-date records of CMS changes and validate pricing systems through testing.
• Collaborate with CMS and Shared System Maintainers to implement and validate system changes.

Skills

Analytical thinking

Problem-solving

Organizational skills

Collaboration

CMS/FISS/MCS familiarity

Education

Bachelor's degree in Health System Information or related

Tools

FISS pricing files

MCS pricing files

Job description

The Medicare Pricing Analyst at WPS—A health solutions company will research and resolve complex CMS pricing and reimbursement issues, ensuring accurate claims processing and pricing updates. You will collaborate with CMS and MACs to validate system changes and respond to internal requests, supporting pricing accuracy across Part A and Part B.

The role emphasizes data integrity, documentation, and cross-team support, with a hybrid work arrangement and opportunities for professional development.