Job Information
WPS HEALTH SOLUTIONS Provider Certification Analyst Start in MADISON, Wisconsin
JOB REQUIREMENTS: Description Who We Are is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer 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. WPS Health Solutions has been making health care easier for the people we serve for more than . Proud to be military and veteran ready. Culture Drives Our Success WPS\' Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. From 2021 to 2023, WPS Health Solutions was recognized for several awards: Role Snapshot The Provider Certification Analyst position will assist in maintenance of TRICARE Provider File online system, including determination of provider certification, eligibility and network status, and ensure accuracy for TRICARE National provider file shared by all TRICARE offices. In this role you will: Perform data Entry into online internal provider file. Resolve issues via phone, internet or correspondence. Respond to questions and problems through phone calls and written correspondence. Initiate telephone calls to obtain additional information to resolve certification issues. Validate, through research, all data entered into online system is accurate for claims processing. Identify claims processed erroneously and initiate appropriate reprocessing steps. Verify eligibility of providers. Maintain understanding of claim edits, entry, and enter information to correct edits, allowing claims to process. Assign provider number for claims processing. Research jurisdiction and multiple files to determine status and ensure related claims or issues are addressed. Work with various internal departments regarding file content to pay or deny claims and verification of addresses. Resolve special handle issues, claims, or projects as assigned by management. Detect online system issues or deficiencies and notify supervisor, researching and providing documentation. How do I know this opportunity is right for me? If you: Are able to navigate multiple systems and on-line resources to... For full info follow application link. Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/530F70D32550462E Qualified females, minorities, and special disabled veterans and other veterans are encouraged to apply.