Medicare Pricing Analyst - Remote/Hybrid

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

Benefits offered by this job

Remote work options

Merit increase opportunities

401(k) match

Job summary

WPS, a health solutions company, seeks a Medicare Pricing Analyst to research complex Medicare pricing and reimbursement issues, ensuring accuracy of claims processing and coding guidelines while supporting CMS pricing updates.

This role partners with CMS, Shared System Maintainers, and MACs to implement system changes, validates pricing data, maintains documentation, and contributes to pricing projects. Remote and hybrid work options are available.

Qualifications

• Bachelor’s degree in Health System Information or 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, as well as understanding of 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 the ability to coordinate and maintain detailed documentation for Change Requests and TDLs related to pricing.
• Ability to collaborate effectively and support the Technical Claims team on various projects.

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 processing guidelines and pricing accuracy.
• Address requests received via OnBase, researching pricing using CMS resources.
• Review and provide feedback on Fee Schedules and pricing articles for CMS compliance.
• Maintain detailed records of CMS-related changes and perform regular testing/validation.
• Collaborate with CMS and Shared System Maintainers to implement system changes and troubleshoot issues.

Skills

Analytical skills

Problem-solving

Organizational skills

Collaboration

System navigation

Education

Bachelor’s degree in Health System Information

Equivalent combination of education and experience

Tools

FISS/MCS pricing files

Job description

WPS, a health solutions company, seeks a Medicare Pricing Analyst to research complex Medicare pricing and reimbursement issues, ensuring accuracy of claims processing and coding guidelines while supporting CMS pricing updates.

This role partners with CMS, Shared System Maintainers, and MACs to implement system changes, validates pricing data, maintains documentation, and contributes to pricing projects. Remote and hybrid work options are available.