Medicare File Coordinator

Description

Role SnapshotOur Medicare File Coordinator coordinates and performs maintenance and testing as required by policy changes, Shared System Maintainer mandates, or Centers for Medicare and Medicaid Services (CMS) directives within specified timeframes. This includes updating and maintaining system files to report and test issues. Research and provide written responses to internal and external customer inquiries or system issues pertaining to Shared System or files. Researches and responds to interdepartmental referrals, reviews and updates processes and coding guidelines for accuracy and effectiveness.

Salary Range$44,000-53,700 annuallyThe base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.

We are open to remote work in the following approved states : Arizona, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin

In this role, you will :

Complete Centers for Medicare and Medicaid Services (CMS) Change Requests to implement required changes / enhancements.

Requesting, validating maintenance, performing maintenance, System Control Facility coding, testing, validation of testing / coding, annual profile build, and assuring system accuracy.

Maintain documentation.

Download, verify, and install Centers for Medicare and Medicaid Services update files as directed.

Write, test, and cross copy ECPS events for Claims Processing.

Maintain Healthcare Integrated General Ledger Accounting System.

Conduct CEM and IVR patch testing.

Validate changes in the Direct Data Entry System.

Prepare Maintenance Request forms and perform manual system maintenance to load files and updates that cannot be systematically installed.

Provide Fee Schedule Disclosures and pricing articles.

Review, analyze, and provide contractor feedback.

Review, analyze, and test a variety of applications on mainframe and Personal Computer base.

Retain, review, compile and submit information needed for support of litigations.

Provide technical expertise in interpretation of issues relating to Medicare regulations and claims processing.

Prepare and issue notices to inform, educate, or alert operations and customer service areas when systems issues have been identified.

Develop excel based worksheets to assist in manual pricing calculations and verification of CMS pricing files.

Perform processing guideline updates and / or request coding changes for the Targeted Probe and Educate (TPE) audits as needed.

Develop skills to request maintenance to update internal coding and processing guidelines for MCS and FISS.

Attend and actively participate in weekly Functional Workgroup (FWG) Calls for MCS and FISS to develop skills collaborating with other MACs and CMS.

Review Quarterly MCS Screen Manual changes made by MCS, analyze the changes affecting the processing departments and perform the corresponding updates to the internal manual.

What will I gain from this role?

Expanding your skillset in a higher-level specialized claims role.

Being a part of a supportive and collaborative team while also working independently.

Experience working in an environment that serves our Nation’s military, veterans, Guard and Reserves and Medicare beneficiaries.

Work in a continuous performance feedback environment.

Minimum Qualifications

Bachelor's Degree in related field or equivalent post high school and / OR related work experience.

1 or more years of experience in Medicare, Medical Review, Claims, Appeals, OR Customer Service in a healthcare environment.

Possess excellent reading comprehension, written communication, and interpersonal skillsets.

Ability to utilize sound reasoning and analysis for creative problem-solving, as well as ability to overcome regular distractions to meet strict deadlines.

Proficiency in Microsoft Office Suite and / OR HART, OnBase, FISS and MCS systems.

Experience with Part A and Part B Claims or Appeal processing.

Preferred Qualifications

Experience with SecureZip, Cute PDF, Adobe Reader, Center for Medicare & Medicaid internal Applications, SnagIt, internet, intranet, office equipment.

Knowledge / billing of hospital-based claims using the direct data entry system.

Customer Service experience this role includes escalated, or priority experience with Part A and Part B FISS and MCS systems.

MAC contractor experience working with the FISS and MCS systems.

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 )

Please review Remote Worker FAQs () for additional information

Benefits

Remote and hybrid 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 : ( )

Who We Are

WPS, a health solutions company, () is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, 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 has been making healthcare easier for the people we serve for nearly 80 years () . 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 open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce—both current and future—to effectively seek, leverage, and include differing and unique 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.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace : WPS Newsroom - Awards and Recognition. ()

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This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and / or sensitive data to safeguard government resources that provide critical services.

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights () notice from the Department of Labor.