Description
Our
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
Medicare IT Analyst
plays a pivotal role supporting internal technology and systems, and will maintain internal manuals, coordinate updates to pricing files in systems like MCS and FISS, and request changes for Pricing File Updates. The Pricing Procedures Analyst requires active participation in weekly Functional Workgroup (FWG) calls and collaboration with other MACs and CMS. Additionally, they support document maintenance and assist the Technical Claims team with various projects and assignments.
Salary Range
45,000 ~ $56,000
Remote Work Locations
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.
Job Fit
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.
Would enjoy reviewing 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.
Can 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.
Like reviewing, analyzing, and providing feedback on Fee Schedule Disclosures and pricing articles, ensuring compliance with CMS guidelines and internal procedures.
Can 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.
Would thrive working closely with CMS and Shared System Maintainers to implement and validate system changes, troubleshoot issues, and support the enhancement of pricing systems and processes.
Minimum 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 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.
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 https://speedtest.net)
Please review Remote Worker FAQs for additional information
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: https://www.wpshealthsolutions.com/careers/
This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.
Equal Opportunity Employer
We are an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
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