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Results based on filters ( 13 jobs found )

Senior Overpayment Recovery Specialist

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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88672212 293544999 Description Role Snapshot The Senior Overpayment Recovery ...
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Summary
About the job:
Specialist will assist the Overpayment Recovery Team with work direction, workflow, inventory, and coordination of activities and processes within the department. The role will advise and assist employees in the unit and support the resolution of difficult or complex issues. Starting Base Salary : $ 24.00/hr. (may change with experience) Training Location/Schedule: Formal training first two weeks, with non-formal training after. Training shift is either 7:30am-4pm CT or 8am-4:30am CT. Scheduled Shift : Production...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Compensation, Benefits, and Job Analysis Specialists
Career Level / Education:
Bachelor's degree
Salary:
N/A
From:
OhioMeansJobs.com
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Claims Examiner III - LPN

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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88637532 293542689 Description U.S. citizenship is required for this ...
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Summary
About the job:
position due to Department of Defense restrictions. Our Claims Examiner III LPN protects the integrity of the Military Veteran Health (MVH) program by identifying, investigating, and preventing potential fraud, waste, and abuse. They blend clinical expertise with data analysis to evaluate medical necessity, detect unusual utilization patterns, and ensure benefits are administered appropriately. This Claims Examiner collaborates with internal leadership and external oversight partners through clear communication, thorough...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Emergency Medical Technicians
Career Level / Education:
Postsecondary nondegree award
Salary:
N/A
From:
OhioMeansJobs.com
Certifications / Licenses:
Associate Degree in Nursing
Licensed Practical Nurse
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Quality Assurance Manager

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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88549831 293538033 Description Our Quality Assurance Manager coordinates and ...
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Summary
About the job:
oversees the continued development, implementation, and monitoring of the Quality Assurance activities for the Audit and Reimbursement department. They serve as a subject matter expert in Medicare reimbursement and cost reporting, provide technical leadership, monitor quality through periodic reviews, and facilitate ongoing development and implementation of the Quality Assurance process. This QA Manager ensures adherence to the regulations of the Centers for Medicare and Medicaid Services (CMS). They play a critical...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Quality Control Systems Managers
Career Level / Education:
Bachelor's degree
Salary:
N/A
From:
OhioMeansJobs.com
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Contract Coordinator

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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88371592 293529330 Description Role Snapshot The Contract Coordinator is ...
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Summary
About the job:
accountable to maintain and strengthen WPS provider networks by managing existing provider contracts and prospecting and proposing new contracts based on adequacy needs and financial considerations. The role serves as a liaison between WPS and the provider community. Hourly Rate of Pay Work Location Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin The work hours for this role are 8am-5pm Central Time,...
Location:
Darbydale, OH
Job Type:
Full-Time
Contract
Occupation:
Purchasing Managers
Career Level / Education:
Bachelor's degree
Salary:
N/A
From:
OhioMeansJobs.com
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
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Detailed Job Information

Intake Specialist

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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88303552 293525894 Description Role Snapshot The Intake Specialist manages ...
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Summary
About the job:
inbound and outbound communications for Health Services, ensuring accurate intake, documentation and routing of cases. This role supports prior authorizations, claims processing including writing authorization and denial letters, case setup, and triage of tasks while maintaining high standards of accuracy, compliance and customer service. Work Location We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey,...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
N/A
From:
OhioMeansJobs.com
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Pharmacy Vendor Coordinator

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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88248779 293523408 Description Role Snapshot The Pharmacy Coordinator will ...
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Summary
About the job:
oversee development and execution of audit processes that monitor delegated activities performed by the Pharmacy Benefits Manager (PBM). The role will build working expertise in the PBM's online claims system and its capabilities, serving as a knowledgeable resource for the Health Services Contract Center and other internal teams to determine appropriate actions to resolve escalated customer issues. 75-78k, pay may fluctuate based on experience. We are open to remote work in the following approved states: Colorado,...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Pharmacists
Career Level / Education:
Doctoral or professional degree
Salary:
N/A
From:
OhioMeansJobs.com
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Medicare Pricing Analyst

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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88104627 293516461 Description Role Snapshot The Medicare Pricing Analyst is ...
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Summary
About the job:
responsible for researching complex Medicare pricing and reimbursement issues while ensuring the accuracy and effectiveness of Medicare claims processing and coding guidelines. This role supports the implementation and validation of CMS pricing updates, maintains pricing information within Medicare systems, and collaborates with CMS, Shared System Maintainers, and other Medicare Administrative Contractors (MACs) to ensure accurate and timely claims payment. The Medicare Pricing Procedures Analyst also researches and...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
N/A
From:
OhioMeansJobs.com
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Provider Network Reimbursement Analyst

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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88038373 293513330 Description Role Snapshot The Provider Network ...
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Summary
About the job:
Reimbursement Analyst completes data analyses to support operational and strategic decision-making for the organization. The role is responsible for the collection, analysis, interpretation, and presentation of data from various sources, making data and analyses accessible, and delivering actionable data summaries and analyses. The Provider Network Reimbursement Analyst develops and recommends provider network reimbursement rates and processes that support the organization's growth opportunities and competitive position in the...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Business Intelligence Analysts
Career Level / Education:
Bachelor's degree
Salary:
N/A
From:
OhioMeansJobs.com
Certifications / Licenses:
N/A
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

APPEALS REGISTERED NURSE

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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87993150 293508267 Description Role Snapshot The Appeals Nurse examines ...
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Summary
About the job:
medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare regulations and policies. The Appeals RN works in collaboration with the Appeals Examiners/Reps to ensure redeterminations are medically reviewed as needed and completed timely. Salary Range 66-68k The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Medical Records Specialists
Career Level / Education:
Postsecondary nondegree award
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
OhioMeansJobs.com
Certifications / Licenses:
Associate of Science in Nursing
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information

Medical Review Nurse Analyst

Wisconsin Physicians Service Insurance Corp
Darbydale, OH
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87493265 293495388 Description Our Medical Review Nurse Analyst is ...
Details
Summary
About the job:
responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This analyst ensures that providers are being reimbursed appropriately for services provided based on Medicare guidelines. This Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements. Salary Range $68,000 - $70,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and...
Location:
Darbydale, OH
Job Type:
Full-Time
Permanent
Occupation:
Health Informatics Specialists
Career Level / Education:
Bachelor's degree
Salary:
Upper Middle Income Jobs ($50K-$79K)
From:
OhioMeansJobs.com
Certifications / Licenses:
Associate of Science in Nursing
Certified Registered Nurse
Workkeys
Applied Math
N/A
Graphic Literacy
N/A
Workplace Documents
N/A
apply
Detailed Job Information
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