WPS—A health solutions company

Conduct clinical reviews of medical records to ensure compliance with regulatory and payer guidelines and appropriate Medicare reimbursement. Provide education to healthcare providers on current billing and documentation requirements through the TPE program.

The analyst performs financial reconciliations and manages bank information to support operational projects. They are responsible for ensuring all workflows comply with CMS requirements and assisting customers with payment issues.

Responsible for reviewing medical records and clinical documentation to determine service eligibility and payability based on TRICARE policy and evidence-based research. Collaborates with internal teams and providers to ensure compliant outcomes for authorizations, appeals, and medical review claims.

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.