Medicare Pricing Analyst (Remote/Hybrid)

WPS Health Solutions; Newark (NJ); Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote work options

Hybrid work options

401(k) match

Health insurance

Paid time off

Professional development

Job summary

WPS Health Solutions seeks a Medicare Pricing Analyst to research complex Medicare pricing and reimbursement issues, ensuring accurate claims processing and coding guidelines. This role supports CMS pricing updates, maintains pricing data, and collaborates with CMS, Shared System Maintainers, and MACs to ensure timely payment.

The analyst also researches requests, reviews pricing guidance, and assists with system testing and validation to improve pricing operations.

Qualifications

• Bachelor's degree or equivalent combination of education and experience.
• 1+ year of Medicare Part A and Part B claims processing experience.
• Knowledge of Medicare program, claims processing, and billing procedures.
• Proficient in downloading and installing CMS pricing files (FISS/MCS).
• Strong analytical and problem-solving skills.
• Organizational skills to document Change Requests and TDLs.
• Ability to collaborate with the Technical Claims team.

Responsibilities

• Research complex Medicare pricing and CMS pricing updates.
• Maintain pricing information within Medicare systems.
• Support system testing, validation, and documentation.
• Collaborate with CMS and MACs to ensure accurate claims payment.

Skills

Analytical skills

Problem-solving

Organizational skills

Collaboration

CMS file navigation

Education

Bachelor's degree in Health System Information

Tools

FISS/MCS pricing files

Job description

WPS Health Solutions seeks a Medicare Pricing Analyst to research complex Medicare pricing and reimbursement issues, ensuring accurate claims processing and coding guidelines. This role supports CMS pricing updates, maintains pricing data, and collaborates with CMS, Shared System Maintainers, and MACs to ensure timely payment.

The analyst also researches requests, reviews pricing guidance, and assists with system testing and validation to improve pricing operations.