Pricing/Provider Analyst

Profile

\u003cp\u003e\u003cstrong\u003eWho We Are\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003ca href=\u0022https://www.wpshealthsolutions.com/about/index.shtml\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eWPS Health Solutions\u003c/a\u003e is a leading not-for-profit health insurer in Wisconsin. Our services offer health insurance plans for individuals, families, seniors, and group plans for small to large businesses. We process claims and provide customer service support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. In 2021, WPS Health Solutions celebrates \u003ca href=\u0022https://www.wpshealthsolutions.com/75/\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e75 years\u003c/a\u003e of making health insurance easier for those we serve.\u0026nbsp; Proud to be military and veteran ready.\u0026nbsp;\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003eOur Culture\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eWPS\u0026rsquo; Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive, empowering employee experience, focusing on People, Work, and Conditions. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. We are guided by our Purpose: Together, making health care easier for the people we serve.\u0026nbsp;\u003c/p\u003e
\u003cp\u003eIn 2021, WPS Health Solutions was recognized for several awards including:\u003c/p\u003e
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\u003cli\u003e\u003ca href=\u0022https://www.wpshealthsolutions.com/careers/\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eMadison, Wisconsin\u0026rsquo;s Top Workplaces \u003c/a\u003e\u003c/li\u003e
\u003cli\u003e\u003ca href=\u0022https://topworkplaces.com/october-2021-awards-reveal/\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eTop Workplace national cultural excellence awards for Remote Work and Work-Life Flexibility\u003c/a\u003e\u003c/li\u003e
\u003cli\u003e\u003ca href=\u0022https://www.wpshealthsolutions.com/careers/\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eAchievers 50 Most Engaged Workplaces\u0026reg; with the further honor of Achievers \u0026ldquo;Elite 8\u0026rdquo; winner in the category of Culture Alignment \u003c/a\u003e\u003c/li\u003e
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\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRole Snapshot \u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eMaintain CPro system files with pricing, network, and provider information for appropriate application of in-network and contracted discount adjudication and accurate directory display. Manage multiple source materials for input of accurate and complete provider information for network connections and pricing instructions in coordination with data provided from provider and network departments or entities.\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003eIn this role you will: \u003c/strong\u003e\u003c/p\u003e
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\u003cli\u003eResolve claims processing issues and respond to inquiries using multiple mainframe programs, applications, and databases to maintain provider demographic setups, provider network connections, and pricing instruction connections.\u003c/li\u003e
\u003cli\u003eInterpret or clarify network connections related to geographic exclusions for third party, non-third party, and governmental programs.\u003c/li\u003e
\u003cli\u003eIdentify sender/receiver of information, initiate, and respond to written and telephone inquiries for all lines of business.\u003c/li\u003e
\u003cli\u003eUtilize internal reference material, internet, and telephone contact to validate provider licensing and determine accurate demographic information.\u003c/li\u003e
\u003cli\u003eReview Provider Agreement forms to validate and enter network connections and/or pricing instruction connections Evaluate completeness and relationships.\u003c/li\u003e
\u003cli\u003eAnalyze provider setup problems and workflows. Evaluate all new and revised procedures to determine impact on workflows. Recommend alternate or more efficient procedures.\u003c/li\u003e
\u003cli\u003eDetermine and/or validate new provider network location setups.\u003c/li\u003e
\u003cli\u003eResearch internet websites and databases to obtain provider and pricing information.\u003c/li\u003e
\u003cli\u003eAssist with training and answering questions of new employees for claims resolution and provider updates.\u003c/li\u003e
\u003cli\u003eIdentify potential fraud and report to WPS Special Investigation Unit.\u003c/li\u003e
\u003cli\u003eResearch and maintain provider records specific to B Notice letters and 1099\u0026rsquo;s.\u003c/li\u003e
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\u003cp\u003e\u003cstrong\u003eHow do I know this opportunity is right for me?\u0026nbsp; If you: \u003c/strong\u003e\u003c/p\u003e
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\u003cli\u003ePossess excellent data entry and attention-to-detail skills\u003c/li\u003e
\u003cli\u003eAre able to use Excel and manipulate large spreadsheets for data collection\u003c/li\u003e
\u003cli\u003eHave effective organizational skills with ability to work independently and cooperatively in a team environment\u003c/li\u003e
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\u003cp\u003e\u003cstrong\u003eWhat will I gain from this role?\u003c/strong\u003e\u003c/p\u003e
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\u003cli\u003eEnjoying a remote, independent position with flexible work hours\u003c/li\u003e
\u003cli\u003eAcquiring in-depth knowledge of the full claims lifecycle, as well as claims processing software\u003c/li\u003e
\u003cli\u003eExperience working in an environment that serves our Nation\u0026rsquo;s military, veterans, Guard and Reserves and Medicare beneficiaries\u003c/li\u003e
\u003cli\u003eContinuous performance feedback\u003c/li\u003e
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\u003cp\u003e\u003cstrong\u003eMinimum Qualifications \u003c/strong\u003e\u003c/p\u003e
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\u003cli\u003eHigh school diploma or equivalent\u003c/li\u003e
\u003cli\u003e1 or more years of related work experience\u003c/li\u003e
\u003cli\u003eCOVID-19 vaccination or WPS approval for an accommodation\u003c/li\u003e
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\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ePreferred Qualifications \u003c/strong\u003e\u003c/p\u003e
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\u003cli\u003ePost high school course work in business, communications, or related area\u003c/li\u003e
\u003cli\u003e2 or more years in WPS Commercial Operations, to include\u003c/li\u003e
\u003cli\u003e1 or more years as an Edit Analyst applying healthcare provider and network agreements\u003c/li\u003e
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\u003cp\u003e\u003cstrong\u003eBenefits\u003c/strong\u003e\u003c/p\u003e
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\u003cli\u003eRemote and hybrid work options available\u003c/li\u003e
\u003cli\u003eMerit increase opportunities\u003c/li\u003e
\u003cli\u003e401(k) with \u003cstrong\u003edollar-per-dollar match up to 6% of salary \u003c/strong\u003e(100% vested immediately)\u003c/li\u003e
\u003cli\u003eCompetitive paid time off\u003c/li\u003e
\u003cli\u003eHealth, dental insurance, Teladoc starts \u003cstrong\u003eDAY 1\u003c/strong\u003e\u003c/li\u003e
\u003cli\u003eReview additional benefits \u003ca href=\u0022https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003ehere\u003c/a\u003e\u003c/li\u003e
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\u003cp\u003e\u003ca href=\u0022http://recruiting2.ultipro.com/WIS1003/JobBoard/e6da0c90-f987-63dc-99a9-fb8c9014f57e/Account/Register?cancelUrl=https://recruiting2.ultipro.com/WIS1003/JobBoard/e6da0c90-f987-63dc-99a9-fb8c9014f57e/?q=WPS&o=relevance\u0026amp;redirectUrl=/WIS1003/JobBoard/e6da0c90-f987-63dc-99a9-fb8c9014f57e/JobSearchAgent\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003cstrong\u003eSign up for \u003c/strong\u003e\u003cstrong\u003eJob Alerts\u003c/strong\u003e\u003c/a\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003eFOLLOW US!\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003e\u003ca href=\u0022https://www.linkedin.com/company/wps-health-solutions/\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eLinkedIn\u003c/a\u003e\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003e\u003ca href=\u0022https://www.facebook.com/WPSHealthSolutions/\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eFacebook\u003c/a\u003e\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003e\u003ca href=\u0022https://twitter.com/WPS_HS\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eTwitter\u003c/a\u003e\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e,EqualOpportunityEmployerDescription:Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities,PayTransparencyPolicyStatement:The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c),MatchScore:1.0,HasApplied:false,ApplicationJobBoardName:null,ApplicationJobBoardId:null,DateApplied:null,Salaried:false,CompensationAmount:null,PublishingStatus:1,Links:[],BehaviorCriteria:[],MotivationCriteria:[],EducationCriteria:[],LicenseAndCertificationCriteria:[],SkillCriteria:[],WorkExperienceCriteria:[],JobBoardMemberships:[{JobBoardId:cdefa8ae-f907-5c13-2775-f0106d0aa34a,PublishedInternal:true,PublishedExternal:false,ExternalPostedDate:null,InternalPostedDate:2022-02-28T19:29:06.365Z},{JobBoardId:e6da0c90-f987-63dc-99a9-fb8c9014f57e,PublishedInternal:false,PublishedExternal:true,ExternalPostedDate:2022-02-28T19:29:06.365Z,InternalPostedDate:null}],AssessmentUri:null,AssessmentStatus:null,OpportunityIsClosed:false,TravelRequired:null,TravelDescription:null,SupervisorName:null,Assessments:[],ApplicationId:null,CompensationAnnualMinimum:null,CompensationAnnualMaximum:null,CompensationHourlyMinimum:null,CompensationHourlyMaximum:null,CompensationCurrency:null});

Company info

Wisconsin Physicians Service Insurance Corporation
Website : http://www.wpsic.com