Medicare Pricing Analyst

Summary

WPS is a health solutions company and federal government contractor that supports Medicare claims and health benefits operations. The Medicare Pricing Analyst researches Medicare pricing and reimbursement issues, implements and validates CMS pricing updates, maintains Medicare pricing systems, and collaborates with CMS and related organizations to ensure accurate claims payment. The role also reviews claims, responds to pricing inquiries, maintains documentation, and supports testing and process improvement projects.

Responsibilities

• Implement required changes and enhancements to CMS systems, including requesting, validating, and performing maintenance, coding, testing, and validation. Download, verify, and install CMS update files to ensure system accuracy
• Review Medicare Part A and Part B claims, including complex and specialty claims, to ensure proper application of processing guidelines, payment rules, and manual calculations. Obtain pricing information from Redbook, system files, and CMS resources
• Address Requests for Assistance received via OnBase, conducting in-depth research to provide accurate responses related to pricing using CMS and Shared System Maintainers’ resources
• Review, analyze, and provide feedback on Fee Schedule Disclosures and pricing articles, ensuring compliance with CMS guidelines and internal procedures
• Maintain detailed and up-to-date records of all CMS-related changes and updates, and ensure the accuracy of pricing systems, including performing regular testing and validation to address discrepancies
• Work closely with CMS and Shared System Maintainers to implement and validate system changes, troubleshoot issues, and support the enhancement of pricing systems and processes

Skills

• • Bachelor's degree in Health System Information or a related discipline, or equivalent combination of education and experience
• • 1 or more years of experience in Medicare Part A and Part B claims processing
• • Knowledge of Medicare program and operations, as well as a thorough understanding of claims processing and billing procedures
• • Proficient in navigating systems and/or applications to effectively download and install files (i.e., FISS/MCS pricing files)
• • Strong analytical skills and problem-solving skills
• • Demonstrated organizational skills with ability to coordinate and maintain detailed documentation for the implementation of Change Requests and TDLs related to pricing
• • Ability to collaborate effectively and provide support to the Technical Claims team with various projects and assignments as needed
• • High speed cable or fiber internet
• • Wired (ethernet cable) internet connection from your router to your computer
• • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• • Experience performing yearly Profile Builds related to pricing functions in MCS and FISS preferred
• • Experience with a Medicare Administrative Contractor company

Qualifications

Must Haves

• • Bachelor's degree in Health System Information or a related discipline, or equivalent combination of education and experience
• • 1 or more years of experience in Medicare Part A and Part B claims processing
• • Knowledge of Medicare program and operations, as well as a thorough understanding of claims processing and billing procedures
• • Proficient in navigating systems and/or applications to effectively download and install files (i.e., FISS/MCS pricing files)
• • Strong analytical skills and problem-solving skills
• • Demonstrated organizational skills with ability to coordinate and maintain detailed documentation for the implementation of Change Requests and TDLs related to pricing
• • Ability to collaborate effectively and provide support to the Technical Claims team with various projects and assignments as needed
• • High speed cable or fiber internet
• • Wired (ethernet cable) internet connection from your router to your computer
• • Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)

Nice to Haves

• • Experience performing yearly Profile Builds related to pricing functions in MCS and FISS preferred
• • Experience with a Medicare Administrative Contractor company

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs