[Hiring] Claims Representative 2 @WPS—A health solutions company

Role Description

The Claims Rep 2 processes Medicare claims from receipt through resolution in accordance with applicable policies, procedures, and regulatory requirements. This role ensures timely and accurate claim resolution while maintaining high standards for quality and customer service.

• Hourly Rate of Pay: At least $19.00/hour based on county SCA rates.
• On the job training Monday-Friday between 7:30am-4:00pm CT. Cannot miss any time during the training period.
• Scheduled Shift: Flexible schedule once trained, 8-hour shifts between 6am-6pm CT.
• Work Location: Open to remote work in the following approved states:
  • Colorado
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Iowa
  • Michigan
  • Minnesota
  • Missouri
  • Nebraska
  • New Jersey
  • North Carolina
  • Ohio
  • South Carolina
  • Texas
  • Virginia
  • Wisconsin

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

• Reviewing Medicare Part A and Part B claims including complex and specialty claims, by applying federal and internal guidelines to ensure appropriate application of processing guidelines, payment rules, and manual calculation procedures.
• Handling complex adjustments involving multiple admissions and adjustments regarding pending returned notices.
• Manually adjusting reconsideration, including patient complaints and denials, and processing through the system accordingly.
• Communicating with internal departments, healthcare providers, and members to obtain additional information or clarify claim issues.
• Interacting with providers by phone to resolve pending claim problems.
• Corresponding with providers, other contractors, and QIOs on various claim-related problems.
• Assisting the department in meeting CMS performance metrics and minimum quality and quantity standards.
• Supporting the Claims department and providing back-up for completing staff responsibilities as needed.
• Keeping up to date with changes in regulations, coding standards, and plan policies.
• Meeting requirements of Federal Privacy Act, International Organization of Standards (ISO 9000), Freedom of Information, Desk Disclosure Reference, and WPS conflict of interest and confidentiality.

Qualifications

• High School Diploma or GED or equivalent experience.
• One (1) or more years of experience 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.
• Demonstrated proficiency in data entry with a strong ability to maintain focus and accuracy.
• Ability to multitask, prioritize, problem-solve, and effectively adapt to a fast-paced environment.
• Ability to work independently and meet quality and production standards.

Requirements

• Previous health/Medicare adjudication experience preferred.
• Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims preferred.
• Familiarity with medical terminology, procedure and diagnosis codes preferred.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer.
• High speed cable or fiber internet.
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net ).

Benefits

• Remote work options available.
• Performance bonus and/or merit increase opportunities.
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately).
• Competitive paid time off.
• Health insurance, dental insurance, and telehealth services start DAY 1.
• Professional and Leadership Development Programs.
• Review additional benefits: https://www.wpshealthsolutions.com/careers/