Remote Medicare Pricing Analyst

WPS Health Solutions; Jacksonville (FL); Hybrid; USD 45,000 - 56,000; Full time

Benefits offered by this job

Remote and hybrid work options

Performance bonus and merit increase

401(k) with 100% match for first 3% of

salary and a 50% match for next 2%

Job summary

WPS Health Solutions is seeking a Medicare Pricing Analyst to research complex Medicare pricing and support the accuracy of claims processing and coding guidelines. You will help implement CMS pricing updates, maintain pricing data, and work with CMS, Shared System Maintainers, and MACs to ensure timely payments.

The role requires a health systems background, Medicare Part A/B experience, and strong analytical skills.

Qualifications

• Bachelor's degree in Health System Information or related discipline.
• 1+ years of experience in Medicare Part A and Part B claims processing.
• Knowledge of Medicare program and operations, plus understanding of claims processing and billing procedures.
• Proficient in navigating systems to download/install files (FISS/MCS pricing files).
• Strong analytical and problem-solving skills.
• Demonstrated organizational skills with ability to coordinate documentation for Change Requests/TDLs.
• Ability to collaborate effectively with the Technical Claims team on projects.

Responsibilities

• Research complex Medicare pricing and reimbursement issues and ensure accuracy of pricing updates.
• Support CMS pricing updates, maintain pricing information within Medicare systems, and collaborate with CMS and MACs.
• Research and respond to interdepartmental requests and provide feedback on pricing guidance and disclosures.
• Assist with testing/validation, maintain internal documentation, and support pricing system enhancements.
• Collaborate with CMS/Shared System Maintainers to implement system changes and address discrepancies.
• Maintain detailed records of CMS-related changes and perform regular testing and validation.

Skills

Analytical skills

Problem-solving

Organizational skills

Collaboration

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 Medicare pricing and support the accuracy of claims processing and coding guidelines. You will help implement CMS pricing updates, maintain pricing data, and work with CMS, Shared System Maintainers, and MACs to ensure timely payments.

The role requires a health systems background, Medicare Part A/B experience, and strong analytical skills.