Remote Medicare Pricing Analyst

WPS Health Solutions; Green Bay (WI); Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote work options

Performance bonus

401(k) match

Paid time off

Health and dental insurance

Telehealth

Development programs

Additional benefits info

Job summary

WPS Health Solutions, based in Madison, WI, seeks a Medicare Pricing Analyst to research complex pricing and reimbursement issues and ensure claims processing accuracy. You will support CMS pricing updates and collaborate with CMS and MACs to validate pricing data.

The role requires a Bachelor’s degree in Health System Information or related field and at least 1 year of Medicare Part A/B claims experience, with strong analytical and documentation skills.

Qualifications

• Bachelor's degree in Health System Information or a related discipline or equivalent experience.
• 1+ years of Medicare Part A and Part B claims processing experience.
• Knowledge of Medicare program, operations, and claims processing/billing procedures.
• Proficient in downloading/installing files using CMS/FISS/MCS systems.
• Strong analytical and problem-solving skills.
• Demonstrated organizational skills for Change Requests and TDLs pricing documentation.
• Ability to collaborate with the Technical Claims team on projects.

Responsibilities

• Implement changes to CMS systems, including requesting, validating, testing, and validating CMS update files.
• Review Medicare Part A and Part B claims, determine proper processing and pricing from CMS resources.
• Address Requests for Assistance via OnBase with CMS pricing information.
• Review Fee Schedule Disclosures and pricing articles for CMS guideline compliance.
• Maintain up-to-date CMS changes and validate pricing systems with testing.

Skills

Analytical skills

Problem solving

Organizational skills

Documentation

Collaboration

Education

Bachelor's degree in Health System Information or related discipline

Tools

FISS/MCS pricing files

Job description

WPS Health Solutions, based in Madison, WI, seeks a Medicare Pricing Analyst to research complex pricing and reimbursement issues and ensure claims processing accuracy. You will support CMS pricing updates and collaborate with CMS and MACs to validate pricing data.

The role requires a Bachelor’s degree in Health System Information or related field and at least 1 year of Medicare Part A/B claims experience, with strong analytical and documentation skills.