Medicare Pricing & Claims Specialist (Hybrid)

WPS Health Solutions; Houston (TX); Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote work options

Hybrid work options

Performance bonus

401(k) match

Paid time off

Health insurance

Dental insurance

Telehealth services

Professional development

Job summary

WPS Health Solutions seeks a Medicare Pricing Analyst to research complex pricing and reimbursement issues and ensure accurate Medicare claims processing and coding guidelines. You will support CMS pricing updates and maintain pricing data across Medicare systems.

Collaborate with CMS, Shared System Maintainers, and MACs to validate changes, review Part A/B claims, obtain pricing data, and keep detailed CMS change records for system accuracy and compliance.

Qualifications

• Bachelor's degree or equivalent in health information or related field.
• 1+ year of Medicare Part A/B claims processing experience.
• Thorough understanding of Medicare program operations and billing.
• Ability to download and install CMS/FISS pricing files.
• Strong analytical and problem-solving capabilities.
• Excellent organizational skills for Change Requests and TDLs.

Responsibilities

• Implement changes to CMS systems, including validation and testing of updates.
• Review Part A/B claims and apply processing guidelines and pricing rules.
• Obtain pricing information from Redbook and CMS resources.
• Address pricing inquiries via OnBase with CMS resources.
• Review Fee Schedule Disclosures and pricing articles for CMS compliance.
• Maintain accurate CMS change records and test pricing systems regularly.

Skills

Analytical skills

Collaboration

Problem-solving

Organizational skills

Education

Bachelor's degree in Health System Information or related discipline

Tools

FISS/MCS pricing files

Job description

WPS Health Solutions seeks a Medicare Pricing Analyst to research complex pricing and reimbursement issues and ensure accurate Medicare claims processing and coding guidelines. You will support CMS pricing updates and maintain pricing data across Medicare systems.

Collaborate with CMS, Shared System Maintainers, and MACs to validate changes, review Part A/B claims, obtain pricing data, and keep detailed CMS change records for system accuracy and compliance.