Joelander Wheeler MBA Doctoral Candidate

My responsibilities include: Reviewing individual provider contracts together with WellPoint and CMS guidelines to ensure compliant and accurate configuration of critical information systems. Analyzing each new provider contract for coverage, policy, reimbursement development, and implications for system edits. (May also perform CPT/HCPCS code and fee schedule updates) Responding to system inquiries and appeals-- primarily in order to troubleshoot claims adjudication issues related to configuration. Conducting research of claims systems and system edits to identify issues and to audit claims adjudication for accuracy. Performing pre-adjudication claims reviews (configuration testing) to ensure proper configuration was used. Prepares correspondence to providers regarding coding and fee schedule updates. Trains customer service staff on system issues. Working with provider contracting staff when new/modified reimbursement contracts are needed. Assisting with the analysis, documentation, configuration, and testing of current and future markets business requirements. Supporting the upgrade of test environments.