Medicare Pricing Analyst — Remote/Hybrid, CMS Updates

WPS—A health solutions company; Indiana (PA); Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote/Hybrid options

Bonus opportunities

401(k) match

Paid time off

Health & dental

Leadership development

Job summary

WPS is seeking a Medicare Pricing Analyst to research complex Medicare pricing, validate CMS updates, and ensure accurate claims processing. You will collaborate with CMS and MACs to implement pricing changes and maintain documentation.

The role requires at least 1 year of Medicare claims experience, a bachelor’s degree in a health information field, and strong analytical and organizational skills. Hybrid work with some remote options available.

Qualifications

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

Responsibilities

• Implement CMS system changes including coding, testing, and validation.
• Review Part A and Part B claims to ensure proper rules and calculations.
• Respond to pricing inquiries via OnBase using CMS resources.
• Review Fee Schedule Disclosures and pricing articles for CMS compliance.
• Maintain records of CMS changes and perform regular testing.
• Collaborate with CMS and Shared System Maintainers to improve pricing systems.

Skills

Analytical skills

Problem-solving

Organizational skills

Collaboration

Education

Bachelor’s degree in Health System Information

Tools

FISS/MCS pricing files

Job description

WPS is seeking a Medicare Pricing Analyst to research complex Medicare pricing, validate CMS updates, and ensure accurate claims processing. You will collaborate with CMS and MACs to implement pricing changes and maintain documentation.

The role requires at least 1 year of Medicare claims experience, a bachelor’s degree in a health information field, and strong analytical and organizational skills. Hybrid work with some remote options available.