Job Description:

Description

Role Summary: Provide analytical, administrative, and technical assistance in meeting goals of annual Medical Review strategy through development and maintenance of a variety of databases

for monitoring, recording, and reporting purposes. Perform support services to internal and external customers.

In this role you will:

• Perform business functions specific to department, including preparation of case files or workload; compiling statistical data, claims, and medical records; data input, tracking, verification and analysis; and assignment, reporting, and monitoring of workload.


• Run queries and develop formulas to identify specific information for required reports and management requests.


• Generate ad hoc reports, merge documents, import and extract data, update and maintain spreadsheets, as well as prepare form letters and other miscellaneous documents.


• Communicate with external contacts (providers, contractors, consultants) to obtain, clarify, or provide information and documentation.


• Assist in development and review of department processes and procedures, making recommendations for improvement. Responsible for incorporating CMS directives that result in procedural changes. Compose and follow documented procedures to complete tasks.


• Generate, prepare, mail, and track departmental provider correspondence (by use of U.S. Postal Certified and FedEx mail), maintaining documentation in provider files.


• Schedule and coordinate departmental and quality meetings. Attend meetings and summarize key points of discussion, requiring interpretation of complex medical terminology.


• Act as unit educator and resource person for nurses concerning technical process for review and/or tracking of electronic claims.


• Monitor aged claims and assign to nursing staff when indicated. Maintain and disseminate to appropriate personnel a log of aging claims inventory.

This role could be a good fit if you:

• Have strong professional communication skillsets coupled with a customer service mindset


• Would like to be a part of a small, closeknit team with a variety of interesting work functions


• Possess excellent attention-to-detail and organizational skillsets


• Would like to have a say in creating operating efficiencies

You'll benefit from this experience by:

• Gaining excellent Medicare knowledge and experience


• Working from home in an independent position


• Enjoying an excellent work/life balance and a flexible schedule that encompasses core business hours


• Working in an environment that serves our Nation's military, veterans, Guard and Reserves along with their families.

You need to have:

• High School Diploma or equivalent

We also prefer:

• Post high school course work in computer software applications, such as word processing, spreadsheet, or database


• 2 or more years of office experience with progressive responsibility in administrative support role, preferably in a medical facility or health insurance industry, with working knowledge of medical terminology and experience in developing reports using spreadsheet and query applications


• Completion of medical terminology course


• Medicare knowledge and experience


• Experience in FISS operating systems and automations

Compensation and Benefits

• Eligible for annual Performance Bonus Program


• 401(k) with dollar-per-dollar match up to 6% of salary
  


• Competitive paid time off


• Health and dental insurance start DAY 1
  


• Vision insurance


• Flexible spending, dependent care, and health savings accounts


• Short- and long-term disability, group life insurance


• Dress for your day


• Innovative professional and cognitive development programs

Who We Are

WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.

Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government's Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.

Learn more about WPS.

Our Purpose and Values

Our purpose is to make healthcare easier for those we serve. Click Here

Our values - Customer Focused, Individual Responsibility, Mutual Respect, and Driven & Passionate - are the core of who we are and how we conduct business every day.

WPS Health Insurance

WPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.

http://wpshealthsolutions.com/business-units/wpshi.shtml

Military and Veterans Health

WPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.

http://wpshealthsolutions.com/business-units/wpsmvh.shtml

Government Health Administrators

WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare & Medicare Services, we've served Medicare beneficiaries and their health care providers since 1966.

http://wpshealthsolutions.com/business-units/wpsgha.shtml

WPS Health Plan

WPS Health Plan offers Health Maintenance Organization and Point-of-Service plans to the group and individual markets in eastern and north-central Wisconsin, plus third-party administrator services.

http://wpshealthsolutions.com/business-units/wpshi.shtml

EPIC Specialty Benefits

EPIC Specialty Benefits provides businesses group insurance products that cover:

• Life


• Disability


• Dental


• Vision


• Voluntary benefits

http://wpshealthsolutions.com/business-units/epicsb.shtml

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