Medicare Pricing Analyst

Role Snapshot

The Medicare Pricing Analyst is responsible for researching complex Medicare pricing and reimbursement issues while ensuring the accuracy and effectiveness of Medicare claims processing and coding guidelines. This role supports the implementation and validation of CMS pricing updates, maintains pricing information within Medicare systems, and collaborates with CMS, Shared System Maintainers, and other Medicare Administrative Contractors (MACs) to ensure accurate and timely claims payment.

The Medicare Pricing Procedures Analyst also researches and responds to interdepartmental requests, reviews Medicare pricing guidance, supports system testing and validation, maintains internal documentation, and assists the Technical Claims team with projects that improve the accuracy and efficiency of Medicare pricing operations.

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The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Employees within 45 miles of WPS Headquarters (1717 W. Broadway in Madison, WI, 53713) will be expected to work hybrid, 2 days a week onsite on a regular basis.

We are open to remote work in the following approved states:
Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin (more than 45 miles from Madison).

• 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.

• 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.

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

• 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 ).
• Please review Remote Worker FAQs for additional information.

• 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
• Review additional benefits: ()

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad.

WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran…