Provider Enrollment Analyst/Credentialing

WPS Health Solutions New • Madison, WI

1d • Remote

About The Position

The Provider Enrollment Analyst will approve, deny, or return applications submitted by Medicare providers. This work is important in helping providers enroll in the Medicare program. This role is remote and offers flexible scheduling. The company, WPS Health Solutions, is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin, serving individuals, families, seniors, and businesses, as well as managing benefits for military personnel. The position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s) and is subject to federal regulations, CMS contract requirements, and internal policies regarding data security, privacy, confidentiality, and program integrity. Personnel are subject to screening and background investigation.

Requirements

• High school diploma or equivalent
• 1 or more years of business experience, including working in the insurance industry, claims processing, health care credentialing, billing or medical reimbursement.
• Confidence in navigating a computer to process applications efficiently through multiple operating systems.
• Ability to prioritize effectively, stay on task, and work independently.
• Comfortable critically examining, analyzing and reviewing work items in detail for accuracy.
• Strong communication skills, both verbal and written.
• Enjoy research and problem-solving.
• 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

Nice To Haves

• Associate degree in business administration, insurance, healthcare, or related fields.
• 2 or more years of business experience, including working in the insurance industry, claims processing, health care credentialing, billing or medical reimbursement.
• Experience interpreting government regulations and applying to current processes.
• Course work in insurance, medical, customer service and/or financial.
• 1 or more years of computer and navigation experience; preferably working with dual monitors.
• Good work ethic and good attendance.
• Ability to communicate effectively over the phone.
• Experience working in a production-based environment.

Responsibilities

• Approve, deny, or return applications submitted by Medicare providers.
• Utilize on-line Medicare files/systems to verify research, update, and document enrollment information.
• Respond to provider/customer enrollment telephone and written inquiries.
• Ensure all provider enrollment data is properly controlled and tracked to ensure applications are approved or denied within standards of timeliness established by department and Centers for Medicare and Medicaid Services (CMS).
• Enter data into on-line national database and internal provider files (PECOS).
• Research and verify proper fees and inspections have been completed on certain suppliers.

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
• Flexible work hours
• Opportunity to work remotely

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED