Medicare IT Analyst - Pricing Procedures Analyst

Medicare IT Analyst - Pricing Procedures Analyst This position is responsible for researching and responding to interdepartmental referrals while ensuring accurate processing and coding guidelines. The analyst supports internal technology systems, maintains internal manuals, coordinates updates to pricing files in MCS and FISS, requests changes for pricing file updates, participates in weekly Functional Workgroup calls, collaborates with MACs and CMS, and supports document maintenance and Technical Claims team projects. Salary Range $45,000 ~ $56,000 Remote Work 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 Job Fit Summary Implement required changes and enhancements to CMS systems, including request, validation and maintenance of 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. Minimum Qualifications Bachelor’s degree in Health System Information or a related discipline, or equivalent combination of education and experience. At least 1 year of experience in Medicare Part A and Part B claims processing. Knowledge of Medicare program and operations, and a thorough understanding of claims processing and billing procedures. Proficiency in navigating systems and/or applications to download and install files (e.g., 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. Preferred Qualifications Experience performing yearly Profile Builds related to pricing functions in MCS and FISS. Remote Work Requirements Wired (ethernet cable) internet connection from router to computer. High‑speed cable or fiber internet. Minimum 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at speedtest.net). 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. Additional detailed benefits available on the company website. This position supports services under Centers for Medicare & Medicaid Services (CMS) contracts. The role is subject to all applicable federal regulations, CMS contract requirements and company internal policies, including 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. #J-18808-Ljbffr WPS—A health solutions company