WPS—A health solutions company

The Provider Enrollment Analyst is responsible for processing, approving, or denying Medicare provider applications using national databases like PECOS. The role involves verifying enrollment information, responding to inquiries, and ensuring compliance with CMS timeliness standards.

The Claims Examiner II reviews and assesses incoming appeals, applying relevant policies to make accurate decisions. They also organize case files and partner with the RN team for medical documentation reviews.

The Cost Report Auditor conducts audits and desk reviews of Medicare Cost Reports to ensure compliance with CMS regulations. They analyze financial and statistical data to verify the accuracy of provider submissions and support effective healthcare reimbursement.

The analyst is responsible for researching and responding to interdepartmental referrals while ensuring the accuracy of processing and coding guidelines. They also coordinate updates to pricing files in systems like MCS and FISS and collaborate with CMS and other MACs.

This role oversees the full lifecycle of provider and vendor agreements, focusing on negotiating competitive contract terms, drafting agreements, and ensuring regulatory compliance to support high-quality healthcare delivery. Key duties involve negotiating reimbursement rates, managing renewals, resolving disputes, and optimizing contract performance to meet business objectives.