Medicare IT Analyst - Pricing Procedures Analyst
About The Position
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 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. 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 How do I know this opportunity is right for me? If you: 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.
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 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.
Nice To Haves
- Experience performing yearly Profile Builds related to pricing functions in MCS and FISS.
Responsibilities
- Researching and responding to interdepartmental referrals while ensuring the accuracy and effectiveness of processing and coding guidelines.
- Maintaining internal manuals.
- Coordinating updates to pricing files in systems like MCS and FISS.
- Requesting changes for Pricing File Updates.
- Active participation in weekly Functional Workgroup (FWG) calls and collaboration with other MACs and CMS.
- Supporting document maintenance.
- Assisting the Technical Claims team with various projects and assignments.
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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
