Medicare Pricing Analyst

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.

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.
• Assist the Technical Claims team with projects that improve the accuracy and efficiency of Medicare pricing operations.

Requirements

• 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 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.

Preferred Qualifications

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

Remote Work Requirements

• 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 speedtest.net).

Pay

Salary Range: $45,000 - $56,000. The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.

Schedule

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. Remote work is available 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).

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 starting on day 1.
• Professional and Leadership Development Programs.

About the Company

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 ready.

Culture

WPS’ culture is where the great work and innovations of our people are seen, fueled, and rewarded. We create an open and empowering employee experience, recognizing the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.