Who We Are
Wipro is continuing to grow in 2024! More opportunity for advancement too!
Wipro is a leading, publicly traded, global IT Solutions and Services company with over 200,000 dedicated employees serving clients across multiple continents and over sixty countries.
Wipro is seeking individuals who combine excellent customer service and problem-solving skills with the ability to function effectively as part of a team or on an individual basis to bring their talent to our team.
We offer a strong compensation package that includes competitive pay and day one benefits. Wipro also offers many opportunities for career advancement within our engaging and exciting culture.
Job Summary and what you'll be doing
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The Provider Contract Auditor is a member of a cross functional team of business experts tasked to work independently and collectively to manage the configuration and pricing reimbursement of various contracts within a core medical and dental claims administrative platform. The analyst will play a key role in obtaining and analyzing requirements, configuring the system components and reviewing/validating the configuration with the Business owners to ensure requirements and quality goals are met.
- Provides analysis and documentation that supports pricing requirements, contract design and contract configuration to accurately apply reimbursement allowances.
- Provides support for activities related to training and communication for configuration/system capabilities, pricing and contract interpretation.
- Support overall system enhancements for reimbursement methodologies in design and testing.
- Works closely with Carriers, Clients and Internal Management to identify and implement new procedures and processes to improve department efficiencies or as instructed.
- Interpreting medical/insurance codes such for procedure and diagnosis.
- Support testing and audit requirements.
- Update customer specific documentation and reference materials.
- Participates in client meetings representing our team for full understanding of client intent.
- Participates and facilitates meetings to support decision making, enhancements, problem solving and process improvement.
- Answers inquiries from clients, claims and customer service.
- Documents policy and procedures.
- Contributes towards daily departmental performance and service level guarantees and achieves individual performance goals around accuracy and timeliness.
Must Haves
- Strong understanding of pricing methodologies for insurance claaim
- 5-7 years of experience in insurance industry.
- Strong CPT/HCPCS Procedure code, revenue code and ICD 10 knowledge.
- High aptitude for working with numbers.
- Ability to coordinate activities with team members.
- Ability to multi-task, adapt to change, manage shifting priorities and meet timelines.
- Possesses excellent interpersonal and communication skills.
- Detailed knowledge of all medical claim coding requirements.
- Strong attention to detail, analytical skills and problem-solving skills.
- Must have solid work ethic and positive demeanor.
- Strong computer knowledge.
- Efficient with Microsoft Office products.