WPS Health Group

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Business Specialist (Medicare Process Coordinator)

at WPS Health Group

Posted: 5/30/2019
Job Status: Full Time
Job Reference #: 69f289b1-dde0-4a6b-aea6-08543787fb51
Keywords:

Job Description

Who We Are

We are a leading not-for-profit health insurer in Wisconsin, and our services have grown to reach active-duty and retired military personnel, seniors, and families in Wisconsin, across the U.S., and around the world. Learn more!

WPS receives World's Most Ethical Company Award for 10th Year in a Row 2019 Most Ethical Companies Announcement

At Our Core

WPS Health Solutions has earned a reputation as a leader in the insurance and benefits administration industry through our commitment to excellence and high-quality service. Our corporate values reflect the core of who we are and how we conduct business every day.

Customer Focused

I recognize how my actions impact internal and external customers by being responsible for the customer experience. I look beyond the immediate issue to recognize and solve the problem.

Individual Responsibility

I own my actions. I am accountable and dedicated to achieving the best results for WPS Health Solutions and our customers. I embrace my role in helping the company achieve a high-performance workplace.

Mutual Respect

I lead by example and act ethically, honestly and am trustworthy. I show appreciation for others by giving and taking constructive feedback and encouragement. 

Driven and Passionate

I approach my work with enthusiasm, and personal commitment to the success of our business. I keep the importance of the work we do for our customers alive in my attitude and interactions with others, and demonstrate pride in the worthiness of our purpose.

Position Summary

The Business Specialist (Medicare Process Coordinator) will perform business analysis functions for Medicare Reimbursement relating to establishment, audit, and quality assurance practices and procedures to comply with Centers for Medicare Services (CMS) directives and business needs, as well as serve as liaison.

Once the employee is performing at an acceptable level (1-2 months approximately of training on-site), they will be offered the opportunity to work from home up to 3 days per week in the state of Nebraska.

In this role you will:

  • Provide financial Reporting for daily, weekly, bi-monthly, monthly, quarterly, and annual activities completed for CMS and internal tracking purposes. Collect and analyze data in regard to receivables and debt collection activities. Analyze and process Treasury collections, debts returned from Treasury, and potential debts eligible for write off. Review and reconcile financial reports for completeness and accuracy. Provide documentation and answer questions in conjunction with internal and external audits.
  • Compile relevant data for CMS/OGC in bankruptcy court proceedings, as well as relate instructions to Medicare staff for handling of all activities in connection with bankruptcy.
  • Oversee Change Requests (CR)/Technical Direction Letters (TDL) by assigning and tracking for timely completion. Update work instructions/forms/letters/ reports to ensure compliancy with CMS regulations. Notify/ instruct and/or train staff on changes. Lead workgroups to discuss implementation of changes to processes. Review and analyze draft CRs to identify workload impact to Reimbursement as it relates to Statement of Work (SOW). Work with Manager to establish a level of effort.
  • Update, create, and maintain all work instructions to ensure document control in accordance with CMS regulations and ensure WPS maintains International Organization for Standardization (ISO) compliancy.
  • Obtain and analyze all pertinent financial statements relating to Extended Repayment Schedules, ensuring accuracy and completeness. Create amortization schedule, input data into financial system, recommend for approval and/or denial, and recalculate amortization schedule when offsets have been identified to reduce debt.
  • Ensure quarterly system testing of financial systems and Reimbursement critical processes, testing for any workload transitions.
  • Obtain and analyze all pertinent documents relating to CRNA (Certified Registered Nurse Anesthetist) Pass-Thru Payments, review submitted information for accuracy and completeness, determine if provider is eligible, approve or deny requests, and instruct staff to update the applicable system.
  • Exercise independent judgment and discretion by reviewing and analyzing financial documents to determine if provider qualifies for extended payment schedules, testing updates to systems and making judgment whether updates to test scripts pass or fail, assisting with provider bankruptcy processes, as well as hosting apx 2 training classes each year to train Reimbursement Analysts and Senior Reimbursement Analysts on updates to department processes.

You should have:

  • Associate’s degree in Business, Finance, Accounting, or related field OR equivalent post high school education and/or work-related experience
  • 1 or more years in business background with accounting experience

We also prefer:

  • 1 or more years working with Medicare Program regulations

 

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