Medicare Pricing Analyst - Remote/Hybrid

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

Benefits offered by this job

Remote and hybrid work options

Performance bonus

401(k) match

Paid time off

Health insurance

Telehealth

Professional development

Job summary

WPS Health Solutions is seeking a Medicare Pricing Analyst to research complex pricing and reimbursement issues, ensuring accurate claims processing and coding guidelines. You will support CMS pricing updates, maintain pricing data in Medicare systems, and collaborate with CMS and MACs for timely payments.

You will also analyze pricing guidance, assist with testing and validation, and contribute to internal documentation and pricing projects across the organization.

Qualifications

• Bachelor’s degree in Health System Information or related discipline, or equivalent 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 downloading/installing CMS pricing files (FISS/MCS).
• Strong analytical and problem-solving skills.
• Excellent organizational skills for Change Requests and pricing-related documentation.
• Ability to collaborate with the Technical Claims team on various projects.

Responsibilities

• Implement CMS system updates, validate changes, and perform testing and verification.
• Review Part A/B claims and pricing using CMS resources and Redbook data.
• Address intra-company requests and provide pricing-related research and responses.
• Review Fee Schedules and pricing articles for CMS guideline compliance.
• Maintain up-to-date CMS changes and perform regular testing to address discrepancies.
• Work with CMS and Shared System Maintainers to implement and validate system changes.

Skills

Analytical skills

Organizational skills

Collaborative teamwork

Education

Bachelor’s degree in Health System Information

Tools

FISS

MCS pricing files

Job description

WPS Health Solutions is seeking a Medicare Pricing Analyst to research complex pricing and reimbursement issues, ensuring accurate claims processing and coding guidelines. You will support CMS pricing updates, maintain pricing data in Medicare systems, and collaborate with CMS and MACs for timely payments.

You will also analyze pricing guidance, assist with testing and validation, and contribute to internal documentation and pricing projects across the organization.