Remote Medicare Pricing Analyst | CMS & Claims Strategy

WPS—A health solutions company; South Carolina; 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 full/company match

Competitive PTO and health benefits

Job summary

WPS Health Solutions is seeking a Medicare Pricing Analyst to research complex Medicare pricing and CMS updates, ensuring accurate claims processing and coding guidelines. You will collaborate with CMS and MACs, address pricing requests, and maintain internal documentation to improve pricing operations.

The role offers hybrid work with 2 days onsite near Madison, WI, and remote options in select states. A Bachelor's in health information or related field plus 1+ year Medicare experience is

Qualifications

• Bachelor’s degree or equivalent in health information or related field.
• 1+ year of Medicare Part A/B claims processing experience.
• Knowledge of Medicare program and billing procedures.
• Proficient at downloading/installing CMS pricing files (FISS/MCS).
• Strong analytical and problem-solving skills.
• Excellent organizational skills for Change Requests and TDLs.

Responsibilities

• Implement CMS system changes, validate updates, and verify pricing accuracy.
• Review Part A/B claims and determine proper payment rules and calculations.
• Address pricing inquiries via OnBase using CMS resources.
• Review Fee Schedule Disclosures and pricing articles for CMS compliance.
• Maintain records of CMS changes and validate pricing systems regularly.
• Collaborate with CMS and Shared System Maintainers to improve pricing processes.

Skills

Analytical skills

Problem solving

Documentation

Collaboration

Communication

Education

Bachelor’s degree in Health System Information or related discipline

Tools

FISS/MCS pricing files

CMS systems

Job description

WPS Health Solutions is seeking a Medicare Pricing Analyst to research complex Medicare pricing and CMS updates, ensuring accurate claims processing and coding guidelines. You will collaborate with CMS and MACs, address pricing requests, and maintain internal documentation to improve pricing operations.

The role offers hybrid work with 2 days onsite near Madison, WI, and remote options in select states. A Bachelor's in health information or related field plus 1+ year Medicare experience is