Remote Medicare Pricing Strategist

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

Benefits offered by this job

Remote work options

Bonus eligibility

401(k) match

Paid time off

Health insurance

Professional development

Job summary

WPS Health Solutions is seeking a Medicare Pricing Analyst to research complex pricing and reimbursement issues, ensuring accurate claims processing and coding guidelines. You will support CMS pricing updates, maintain pricing data in Medicare systems, and coordinate with CMS, Shared System Maintainers, and MACs for timely payments.

The role also involves responding to interdepartmental requests, reviewing pricing guidance, and assisting the Technical Claims team with pricing improvement

Qualifications

• Bachelor’s degree or equivalent in Health System Information or related field.
• 1+ years of Medicare Part A/B claims processing experience.
• Knowledge of Medicare program and operations, claims processing, and billing procedures.
• Proficient in downloading/installing files (FISS/MCS pricing files).
• Strong analytical and problem‑solving skills.
• Organizational skills to document Change Requests and TDLs related to pricing.
• Ability to collaborate with the Technical Claims team.

Responsibilities

• Implement changes to CMS systems, including validating and testing CMS updates.
• Review Part A/B claims to ensure proper processing and pricing.
• Respond to pricing questions using CMS resources.
• Review Fee Schedule Disclosures and pricing articles for CMS guidance.
• Maintain CMS-related change records and validate pricing systems.
• Collaborate with CMS and Shared System Maintainers to implement system changes.

Skills

Medicare pricing knowledge

Claims processing knowledge

Analytical skills

Documentation 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 pricing and reimbursement issues, ensuring accurate claims processing and coding guidelines. You will support CMS pricing updates, maintain pricing data in Medicare systems, and coordinate with CMS, Shared System Maintainers, and MACs for timely payments.

The role also involves responding to interdepartmental requests, reviewing pricing guidance, and assisting the Technical Claims team with pricing improvement