Medicare Claims Processor - REMOTE - Start Date 11/28/2022

Who We Are

WPS Health Solutions 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 celebrated 75 years of making health insurance easier for those we serve. Proud to be military and veteran ready.

Our Culture

WPS’ 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.

In 2021 and 2022, WPS Health Solutions was recognized for several awards including:

• Madison, Wisconsin’s Top Workplaces
• Top Workplace national cultural excellence awards for Remote Work and Work-Life Flexibility
• Achievers 50 Most Engaged Workplaces® with the further honor of Achievers “Elite 8” winner in the category of Culture Alignment

Role Snapshot

This role starts on November 28, 2022 and will process Medicare claims through effective use of online system(s) in accordance with applicable procedures, guidelines, and quality standards. In addition, this role will establish and maintain a professional rapport with contractors and present a favorable corporate image.

Claims Processing (90%)

• Apply federal and internal guidelines (claim filing, jurisdiction, provider eligibility, coverage, and limitations), resulting in payment or denial of services.
• Audit claims for Medicare Part A and part B, including complex claims, specialty claims, and claims requiring manual calculation of payment determinations.
• Apply correct diagnosis and/or procedure codes, modifiers, and reason codes.
• Obtain claim processing information using computer, system files, and reference to beneficiary, provider, and history screens.
• Process routine and complex medical necessity audits per nurse instructions.
• Handle complex adjustments involving multiple admissions and adjustments regarding pending returned notices. Manually adjust reconsideration, including patient complaints and denials, and process through system accordingly.

Team and Customer Support (10%)

• Interact with providers by phone to resolve pending claim problems. Correspond with providers, other contractors, and QIOs on various claim-related problems.
• Assist department in meeting CMS performance metrics and minimum quality and quantity standards.
• Establish 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.
• Support Claims department and provide back-up for completing staff responsibilities as needed.
• Meet requirements of Federal Privacy Act, International Organization of Standards (ISO 9000), Freedom of Information, Desk Disclosure Reference, and WPS conflict of interest and confidentiality.

How do I know this opportunity is right for me? If you:

• Are confident in your skills navigating a computer to process Medicare Part A and B claims efficiently through multiple operating systems.
• Have the ability to make decisions in a timely but accurate manner.
• Can prioritize effectively, stay on task, and work independently.
• Are an innovator and simplifier – always looking to improve current processes.
• Possess strong communication skillsets, both verbal and written.

What will I gain from this role?

• Enjoying a flexible schedule
• Having the opportunity to earn more by being a top performer
• Receiving valuable opportunities for knowledge-sharing with seasoned teammates
• Gaining valuable skillsets with many career growth opportunities within the organization
• Working in an environment that serves Medicare beneficiaries and providers
• Experience working in an environment that serves our Nation’s military, veterans, Guard and Reserves and Medicare beneficiaries
• Continuous performance feedback

Minimum Qualifications

• High school diploma or equivalent

Preferred Qualifications

• One or more years in hospital, clinic and/or medical office billing
• One 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 communications
• Experience with medical coding and/or medical terminology
• Experience working with Medicare

Additional Information

• Start Date: Monday, November 28, 2022
• Training Schedule: Monday through Friday, 7:35am-4:05pm (Central Standard Time) for 14 weeks (training is paid)
• Scheduled Shift: Monday through Friday, flexible shifts between 6:00am-6:00pm, available in-between 2–3-week training modules and once fully trained

Hourly Rate of Pay

• Starting hourly rate: $15.47 based on county SCA rates as well as your job-related knowledge, skills, and experience

Pay for Performance

• Opportunities for pay increases based on performance. You may be eligible for an additional mid-year salary adjustment as well after all phases of training are completed

Work Location

This role is open to remote work for this opportunity in the following approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin

To help strengthen communication, provide a sense of community, and improve the overall remote work experience, the assigned office community based on the position’s division is GHA: Omaha, Nebraska

Remote Worker Requirements

For remote position, employee is required to meet remote worker requirements, including a designated workstation, a wired (Ethernet) connection to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at https://speedtest.net)

Next steps

After submitting your application, we will send you an online assessment. We recommend you try and complete it within two business days. You must complete and obtain a passing score on the assessment to be considered for the position.

Benefits

• Remote work
• Performance bonus opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health, dental insurance, Teladoc starts DAY 1
• Review additional benefits here

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

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)