GHA Claims Representative II Start Date 10/11/2021

Profile

u003cpu003eu003cstrongu003eRole Summary:u0026nbsp; u003c/strongu003eProcess Medicare claims through effective use of online system(s) in accordance with applicable procedures, guidelines, and quality standards. Establish and maintain a professional rapport with contractors and present a favorable corporate image.u003c/pu003enu003cpu003eu003cstrongu003eIn this role you will:u003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eu0026nbsp; u0026nbsp;Claims Processing (90%)u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eApply federal and internal guidelines (claim filing, jurisdiction, provider eligibility, coverage, and limitations), resulting in payment or denial of services.u003c/liu003enu003cliu003eAudit claims for Medicare Part A and part B, including complex claims, specialty claims, and claims requiring manual calculation of payment determinationsu003c/liu003enu003cliu003eApply correct diagnosis and/or procedure codes, modifiers, and reason codesu003c/liu003enu003cliu003eObtain claim processing information using computer, system files, and reference to beneficiary, provider, and history screens.u003c/liu003enu003cliu003eProcess routine and complex medical necessity audits per nurse instructions.u003c/liu003enu003cliu003eHandle complex adjustments involving multiple admissions and adjustments regarding pending returned notices. Manually adjust reconsideration, including patient complaints and denials, and process through system accordingly.u003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eu0026nbsp; u0026nbsp;Team and Customer Support (10%)u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eInteract with providers by phone to resolve pending claim problems. Correspond with providers, other contractors, and QIOs on various claim-related problems.u003c/liu003enu003cliu003eAssist department in meeting CMS performance metrics and minimum quality and quantity standards.u003c/liu003enu003cliu003eEstablish and maintain a positive rapport with internal and external customers. Respond politely to all customers, demonstrating professionalism while working with difficult customers and/or issues of a sensitive nature.u0026nbsp;u003c/liu003enu003cliu003eSupport Claims department and provide back-up for completing staff responsibilities as needed.u003c/liu003enu003cliu003eMeet requirements of Federal Privacy Act, International Organization of Standards (ISO 9000), Freedom of Information, Desk Disclosure Reference, and WPS conflict of interest and confidentiality.u003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eThis role could be a good fit if you: u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eAre confident in your skills navigating a computer to process Medicare Part A and B claims efficiently through multiple operating systemsu003c/liu003enu003cliu003eHave the ability to make decisions in a timely but accurate manneru003c/liu003enu003cliu003eCan prioritize effectively, stay on task, and work independentlyu003c/liu003enu003cliu003eAre an innovator and simplifier u0026ndash; always looking to improve current processesu003c/liu003enu003cliu003ePossess strong communication skillsets, both verbal and writtenu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eYouu0026rsquo;ll benefit from this experience byu003c/strongu003eu003cstrongu003e:u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eEnjoying a flexible scheduleu003c/liu003enu003cliu003eHaving the opportunity to earn more by being a top performeru003c/liu003enu003cliu003eReceiving valuable opportunities for knowledge-sharing with seasoned teammatesu003c/liu003enu003cliu003eGaining valuable skillsets with many career growth opportunities within the organizationu003c/liu003enu003cliu003eWorking in an environment that serves Medicare beneficiaries and providersu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eYou need to have: u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eHigh school diploma or equivalentu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eWe also prefer:u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eOne or more years in hospital, clinic and/or medical office billingu003c/liu003enu003cliu003eOne or more years of post-high school education or coursework in insurance or medical-related studies, and experience in a position using computer, keyboarding, and customer communicationsu003c/liu003enu003cliu003eExperience with medical coding and/or medical terminologyu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eAdditional Information:u003c/strongu003eu003c/pu003enu003culu003enu003cliu003eStart Date: u003cstrongu003eMonday, October 11u003csupu003ethu003c/supu003e, 2021u003c/strongu003eu003c/liu003enu003cliu003ePay for Performance:nu003culu003enu003cliu003eEach quarter offers an opportunity to increase hourly rateu003c/liu003enu003cliu003eAverage increase of top performers: $5.00 per hour above base pay listed aboveu003c/liu003enu003cliu003eTop Performers can earn over $10.00 per hour above base payu003c/liu003enu003c/ulu003enu003c/liu003enu003cliu003eTraining Schedule: Monday through Friday, 7:35am-4:05pm, approximately 10 weeksu003c/liu003enu003cliu003eScheduled Shift: Monday through Friday, flexible shifts between 6:00 am-6:00pmu003c/liu003enu003cliu003eWork from Home: Fully remote position. Able to be located in any WPS remote worker-approved state as long as WPS Remote Work Program requirements are met.u003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eCompensation and Benefitsu003c/strongu003eu003c/pu003enu003culu003enu003cliu003eEach quarter you have the opportunity to increase your pay rate (after the 1st year)u003c/liu003enu003cliu003eAverage Increase: $5.00 per hour above base payu003c/liu003enu003cliu003e401(k) with u003cstrongu003edollar-per-dollar match up to 6% of salaryu003c/strongu003eu003c/liu003enu003cliu003eCompetitive paid time offu003c/liu003enu003cliu003eHealth and dental insurance start u003cstrongu003eDAY 1u003c/strongu003eu003c/liu003enu003cliu003eVision insuranceu003c/liu003enu003cliu003eFlexible spending, dependent care, and health savings accountsu003c/liu003enu003cliu003eShort- and long-term disability, group life insuranceu003c/liu003enu003cliu003eDress for your dayu003c/liu003enu003cliu003eInnovative professional and cognitive development programsu003c/liu003enu003c/ulu003enu003cpu003eu003cstrongu003eWho We Areu003c/strongu003eu003c/pu003enu003cpu003eWPS 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.u003c/pu003enu003cpu003eFounded 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 governmentu0026rsquo;s Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.u003c/pu003enu003cpu003eWPS has been named one of the u003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eWorldu0027s Most Ethical Companiesu003csupu003eu0026reg;u003c/supu003eu003c/au003e by the Ethisphereu003csupu003eu0026reg;u003c/supu003e Institute for 10 years in a rowu003cstrongu003eu003cemu003e.u003c/emu003eu003c/strongu003eu003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eu003cstrongu003eLearn more about WPSu003c/strongu003eu003c/au003eu003cstrongu003e. u003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eOur Purpose and Valuesu003c/strongu003eu003c/pu003enu003cpu003eOur purpose is to make healthcare easier for those we serve. u003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eu003cstrongu003eClick Hereu003c/strongu003eu003c/au003eu003c/pu003enu003cpu003eOur values u0026ndash; Customer Focused, Individual Responsibility, Mutual Respect, and Driven u0026amp; Passionate u0026ndash; are the core of who we are and how we conduct business every day.u003c/pu003enu003cpu003eu003cstrongu003eHealth Insuranceu003c/strongu003eu003c/pu003enu003cpu003eWPS 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.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****and Veterans Healthu003c/strongu003eu003c/pu003enu003cpu003eWPS 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.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****Health Administrators u003c/strongu003eu003c/pu003enu003cpu003eWPS 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 u0026amp; Medicare Services, weu0026rsquo;ve served Medicare beneficiaries and their health care providers since 1966.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****Health Plan provides innovative and high-value health plans to groups and individuals in eastern and northeastern Wisconsin. With our quality Wisconsin-based customer service, Arise offers health care expertise with a personal touch.u003c/pu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****Specialty Benefitsu003c/strongu003eu003c/pu003enu003cpu003eEPIC Specialty Benefits provides businesses group insurance products that cover:u003c/pu003enu003culu003enu003cliu003eLifeu003c/liu003enu003cliu003eDisabilityu003c/liu003enu003cliu003eDentalu003c/liu003enu003cliu003eVisionu003c/liu003enu003cliu003eVoluntary benefitsu003c/liu003enu003c/ulu003enu003cpu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003****connected:u0026nbsp;u003c/strongu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eu003cstrongu003eSign-up for Job Alertsu003c/strongu003eu003c/au003eu003c/pu003enu003cpu003eu003cstrongu003eFOLLOW US!u003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eFacebooku003c/au003eu003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eTwitteru003c/au003eu003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eu003ca href=u0022****target=u0022_blanku0022 rel=u0022noopeneru0022u003eLinkedInu003c/au003eu003c/strongu003eu003c/pu003enu003cpu003eu003cstrongu003eu0026nbsp;u003c/strongu003eu003c/pu003e,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:e6da0c90-f987-63dc-99a9-fb8c9014f57e,PublishedInternal:false,PublishedExternal:true,ExternalPostedDate:2021-09-16T20:47:09.639Z,InternalPostedDate:null},{JobBoardId:cdefa8ae-f907-5c13-2775-f0106d0aa34a,PublishedInternal:true,PublishedExternal:false,ExternalPostedDate:null,InternalPostedDate:2021-09-16T20:47:09.639Z}],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});

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