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Medical Review Nurse Analyst

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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84147159 291503694 Description The Medical Review Nurse Analyst is ...
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responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This role ensures that providers are billing and being paid appropriately for services provided based on Medicare guidelines. The Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements. Salary Range $66,000 - $70,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and...
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Cost Report Audit Director

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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84096880 291245451 Description Role Snapshot Our Cost Report Director leads ...
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a team of several direct reports with 60 or so indirect reports in our Government Health Administrator line of business which focuses on Medicare contracts. In this critical management role, they will be leading teams to ensure all contractual requirements are met for Medicare provider cost report audit and reimbursement activities within approved Centers for Medicare & Medicaid Services (CMS) funding levels. They are accountable to ensure the appropriate amount of reimbursement to approved providers of health care...
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Provider Enrollment Analyst / Credentialing

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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84039693 291019833 Description The Provider Enrollment Analyst will approve, ...
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deny, or return applications submitted by Medicare providers. This work is important in helping providers enroll in the Medicare program. Additional Information: Start Date: August 12th, 2025 Starting Base Pay: $20.50 per hour Training Schedule: (7 Weeks): Monday through Friday, 8:00-4:35pm CST Scheduled Shift: Monday through Friday, 6:00am-6:00pm, Flex Scheduling, max of 10 hours per day and 40 hours minimum per week We are open to remote work in the following approved states: Arizona, Colorado, Connecticut,...
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Applied Math
4
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4
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Customer Service Rep (Call Center- REMOTE)

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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83973909 290705202 DescriptionU.S. citizenship is required for this position ...
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due to Department of Defense restrictions We are seeking a talented Customer Service Rep to join our team! The successful candidate will play a critical role in providing call center telephone support, as well as responses to written inquiries submitted by, military members, retirees, and dependents eligible for both TRICARE and Medicare benefits (TRICARE Medicare Eligible Program - TMEP). In addition, this role is responsible for assisting with claims and billing inquiries from hospitals and clinics. Inquiries can...
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4
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4
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4
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Senior Process Automation Developer

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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83957970 290653595 Description Role Snapshot Our Senior Process Automation ...
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Developer designs, develops, implements and maintains automation solutions to streamline and improve business processes. This developer will partner with business stakeholders and users to understand process requirements, document process flows, and identify automation opportunities. This role requires strong coding skills (C#, VB.NET, VBA, SQL), and the ability to work collaboratively with cross-functional teams to optimize workflows. Will participate in an on-call rotation and assist in research for issue resolution....
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Appeals Nurse

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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83957971 290653952 Description The Appeals Nurse examines medical records ...
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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 and Reps to ensure redeterminations are medically reviewed as needed and completed timely. Salary Range $66,000 - $68,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and...
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4
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5
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4
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Grievance & Appeals Coordinator

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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83921806 290444916 Description As a Grievance and Appeals Coordinator, you ...
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will investigate and resolve complex patient and insurance provider complaints related to claims, enrollment, medical authorization denials, within the healthcare industry. You will act as a liaison between the member, insurance provider, and medical service providers to ensure timely and fair resolution of all appeals and grievances. Reporting processes will be created and maintained in this role to support the overall savings for the company while maintaining the membership and provider support of our company. Hourly...
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Applied Math
5
Graphic Literacy
5
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5
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Azure Developer

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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83860493 290155902 DescriptionU.S. citizenship is required for this position ...
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due to Department of Defense restrictions Role Snapshot Our Azure Developer supports modernization efforts by developing, deploying, and unit-testing secure, scalable applications in Azure within our Data Logistics line of business. This developer will contribute to enhancing customer-facing web portal and underlying platform functionality. These portals power document scanning, printing, mailing, and data extraction services. This developer will work with our Senior Cloud Developer to build and maintain components,...
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5
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5
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7
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Senior Azure Developer

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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83860492 290155812 DescriptionU.S. citizenship is required for this position ...
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About the job:
due to Department of Defense restrictions Our Senior Azure Developer supports modernization efforts by developing, deploying, and unit-testing secure, scalable applications in Azure within our Data Logistics line of business. This developer will play a pivotal role in enhancing customer-facing web portal and underlying platform functionality. These portals power document scanning, printing, mailing, and data extraction services. This developer will build and maintain components, while supporting secure network...
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Certifications / Licenses:
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
7
apply
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Government Pricing Analyst

Wisconsin Physicians Service Insurance Corp
Grove City, OH
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83851361 290100285 Description Role Snapshot Our Government Pricing Analyst ...
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will support key strategic business opportunities through pricing and costing analyses for WPS's new and existing federal government contracts and the Data Logistics line of business. The role assists in pricing negotiations with government agencies and monitors contract modifications to ensure that pricing adjustments are accurately implemented. This position is part of the finance team and reports to the Director of Government Pricing. The Government Pricing Analyst will regularly collaborate both the federal and...
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From:
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Certifications / Licenses:
Workkeys
Applied Math
5
Graphic Literacy
5
Workplace Documents
6
apply
Detailed Job Information
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