[Hiring] Medicare IT Analyst - Pricing Procedures Analyst @WPS—A health solutions company

Role Description

The Medicare IT Analyst - Pricing Procedures Analyst is responsible for researching and responding to interdepartmental referrals while ensuring the accuracy and effectiveness of processing and coding guidelines. This role plays a pivotal part in supporting internal technology and systems, maintaining internal manuals, coordinating updates to pricing files in systems like MCS and FISS, and requesting changes for Pricing File Updates.

• Active participation in weekly Functional Workgroup (FWG) calls.
• Collaboration with other MACs and CMS.
• Support document maintenance.
• Assist the Technical Claims team with various projects and assignments.

Qualifications

• 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 the 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.

Requirements

• Can 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 to 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, ensuring 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.

Preferred Qualifications

• Experience performing yearly Profile Builds related to pricing functions in MCS and FISS.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer.
• High speed cable or fiber internet.
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at speedtest.net ).

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.
• Review additional benefits: WPS Health Solutions Careers .