Financial Analyst - Provider Reimbursement - Salary.com Most people are looking to their health plans for help. For example, Mercy of Iowa City is considered a Level 2 provider. 3With the $900, $3,000 and $4,500 Deductible Plans, the plan will begin to pay 100% of the cost of a covered family members covered expenses if that family member's individual out-of-pocket maximum is met; the plan begins to pay 100% of covered expenses for all covered family members once the family out-of-pocket maximum has been met. (Examples: chiropractor, physical therapist, speech pathologist, occupational therapist, etc.). By clicking Agree, I consent to our data usage policies as stated. 5Deductible does not apply. Non-participating providers do not have contracts with Blue Cross and Blue Shield. Keep in mind: If you choose a Kaiser plan in California, Colorado, the District of Columbia, Georgia, Maryland or Virginia, you are required to select a Primary Care Provider (PCP), who will manage your care. Medicare Plans If your plan doesnt require a referral, just call the specialist to make an appointment. ", For the Narrow network (Iowa only)" plans: Select Wellmark Blue HMO," and then click Confirm selection.". Blue Magazine; . 2. With the Kaiser California $1,850 Deductible Plan, the plan will begin to pay 100% of the cost of a covered family members covered expenses if that family members individual out-of-pocket maximum is met; the plan begins to pay 100% of covered expenses for all covered family members once the family out-of-pocket maximum has been met. Click the checkbox next to the jobs that you are interested in. That means you can see any specialist in the network from OB-GYNs to podiatrists, chiropractors and others. Agent Finder | Wellmark Blue Cross and Blue Shield If youd prefer to get a 90-day supply at a CVS or Walgreens, you can have your doctor provide CVS or Walgreens with a 90-day prescription, ask the pharmacist to contact your doctor if you already have a prescription on file at the pharmacy, or to transfer your current 90-day prescriptions from another pharmacy. GO TO FIND CARE AND SELECT FIND A PROVIDER. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. www.bcbs.com/providers. With lower premiums, the $4,500, $3,000 and $1,850 Deductible Plans give you more opportunity to take control of your health care spending. Blue Distinction Centers+ (BDC+) also met cost measures d. Serve as consultant in collaboration with Network Engagement to provide compensation guidance/expertise and payment policies to providers and applicable stakeholders. Individual outcomes may vary. Pathologists, Hospitalists, and Intensivists who provide services for elective There are times with specific populations where it could be more likely that Doctor on Demand would advise the person to seek in-person care due to potential complications, for example, a newborn or an older adult with multiple health issues. Find it online at Wellmark.com/Blue. Providers in CA, ID, NY, Employees in Iowa who enroll in the Wellmark Narrow Network Plan must assign a Primary Care Physician during the enrollment process for you and your dependents. Call 911 or go to the nearest hospital emergency room. Adjust your contributions as necessary during the year to make sure you have money available when you need it. NPIs, and user security for your organization for purposes of submitting provider applications and change requests in E-credentialing Central. Welcome to our provider network | Wellmark That means you can go to any doctor, clinic or hospital. The Blue Distinction Specialty . 1 Call HealthPartners Behavioral Health Resources at 952-883-5811 or 888-638-8787 for help choosing a clinic. Identifies and implements continuous improvement opportunities. Use the fields under What can we help you find? to select your search criteria. They may also be able to help coordinate your care. The online Doctor On Demand and many of the same providers (about 98%) are part of the Narrow Network; the biggest differences are you can't receive care out of state (except for emergencies, pre-approved referrals, and dependents that live out of state); you must designate a Primary Care Physician; and the number of chiropractic care providers is substantially less. Provider Performance Consultant - Medicare Advantage, Health Services Clinical Support Specialist (Remote eligible after training), Provider Data Innovation Analyst - Medicare Advantage. For more information, including out-of-network coverage details, visit the Mercer Marketplace 365+website. Excellent critical thinking and creative problem solving skills. Blue Cross and Blue Shield do not have contracts with these providers, and they do not agree to accept payment arrangements. Visit Wellmark.com/Blue365 for a full list of deals and discounts available to you. 2The $4,500 Deductible Plan with HSA is not offered by Kaiser. You have more ways than ever to get expert medical opinions and advice. Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [emailprotected], Receive alerts for other Financial Analyst - Provider Reimbursement job openings, Salary.com Estimation for Financial Analyst - Provider Reimbursement in Des Moines, IA. Visit your providers website for more information. Find an In-Network Provider in Iowa and SD | Wellmark You have until November 30 of each year to earn Reward Dollars. Track and organize your family's medical claims and expenses. University Services Building (USB) Select Blue Distinction Centers are healthcare facilities and providers recognized for their expertise in delivering specialty care. If you live in Hawaii, you are only eligible for the Platinum Be Fit Plan offered by Kaiser-Hawaii. Medical - Transamerica Are you sure you wouldnt like a free professional resume evaluation? We are not motivated by profits. Provider Registration - Wellmark Check your plan documents to see how your plan works. Washington County Hospitals & Clinics and The Iowa Clinic, PC, Des Moines, A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat specific symptoms and conditions. HealthSparq One supports your complex benefit designs and quality scores to help drive down costs for both you and your members, while improving healthcare outcomes. Authorization Table - Wellmark Difference Between Participating and Non-Participating Providers, Unpaid J-1 Scholars and J-2 Family Members Benefits, Reviewing Classification and Pay Level Requests, Specified Term Extension and Transfer Guidelines, University Compensation and Classification Contact Us, Employment Categories and Classifications, Merit Supervisory Exempt and Confidential Staff, Merit Probation and Salary Information by Type, Tuition Assistance and Fee Assistance Options, Recruiting, Hiring, and Onboarding New Employees, Work Arrangements and Performance Reviews, Campus Support and Critical Incident Response, UIHC and CCOM Leave and Disability Requests, Immigration Status Classification Summary, Graduate Teaching and Research Assistants (COGS), Staff Nurses and Allied Health Professionals (SEIU), Coping with Loss, Change, and Uncertainty. Visits typically take less than 20 minutes and will typically cost you $50 or less. You may have to file your claims. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. If you are in a state other than Iowa and require medical care, you may call Wellmark Blue Cross and Blue Shield of Iowa at (800) 810-BLUE (2583) for assistance in locating the closest participating provider in that state. Here you can search for doctors, hospitals or clinics by name or specialty. When searching on the Wellmark website for providers, you will use the prefix "XQW.". UIChoice Providers - The University of Iowa Most HealthPartners plans offer both in-network and out-of-network coverage. If you live in Iowa, you have an additional option for medical coverage: the Narrow Network (Iowa only). Your Wellmark health insurance coverage keeps you safe, secure and protected from more than the cost of health care. 6If you take a long-term or maintenance medication to manage a health condition like high blood pressure, diabetes or high cholesterol, the Smart90 program gives you the option to pick up a three-month supply of your medication at a CVS or Walgreens, or have your medication shipped to your home using Express Scripts mail-order pharmacy. Contact Us Y0020_WCM_100876E Last Updated On: 10/1/2022 In Iowa, participating providers will accept payment arrangements and file claims for you with Blue Cross and Blue Shield. your own policys coverage, contact your Local Blue Plan and ask your provider Medical plans: View claims, estimate costs, find a network doctor, and more, Prescription coverage: Order/refill prescriptions, $4,500 Deductible Plan ($9,000 family deductible), $3,000 Deductible Plan ($6,000 family deductible), $1,850 Deductible Plan ($3,700 family deductible), Use the High Deductible Health Plans Wisely, $900 Deductible Plan ($1,800 family deductible), Accidental Death & Dismemberment (AD&D) Insurance, Additional Support for You and Your Family. Visit your carriers website to search for in-network providers and use the tools to compare costs for medical services. Claims are settled with you, not the providers. Want to know more? Newsroom; Related Sites. Looking for a dentist? Iowa City, Iowa 52240, Benefits:319-335-2676Payroll:319-335-2381Administrative Services:319-335-3558, Accessibility notice and website disclaimers. You can get treatment for conditions including cold and flu, allergies, fever and other conditions, such as mental health. All appointment times are guaranteed by our Wellmark Blue Cross Blue Shield Chiropractors & Providers. Find a Doctor; Member Forms; Prescription Drug Info; Important Things to Know; Get Adobe Reader; Company. given to physicians under the Blue Distinction Centers for Fertility Care Job Description About the role: As a Financial Analyst for Provider Reimbursement, you will create, implement and maintain provider compensation strategies, including financial reporting and analysis for all providers with whom Wellmark may contract with. Therefore, the emergency services must be provided to the member in an emergency room setting (not an urgent care center or physicians office). Group Health Plans Your employees help your business thrive. *If you live in California, Colorado, the District of Columbia, Georgia, Maryland or Virginia, Kaiser may be an additional medical carrier option that provides in-network coverage only (availability depends on your home ZIP code). For more efficient service, please have your member ID number handy - it can be found on the front of your card. Provide timely response to provider inquiries via Network Engagement and support data needs and inquiries. C) Salary.com using cookies (as described here) to refine and tailor the website visitor experience. Show Blue Distinction Specialty Care submenu. National criteria for Provide business knowledge and payment processing expertise in projects, if applicable. Coverage would still be under Level 3, but any coinsurance would be applied to the Level 1 & 2 in-network out-of-pocket maximums (OPMs) of $1,700 individual and $3,400 family. Your pre-tax HSA contributions and any earned Reward Dollars from Transamerica can help you pay your out-of-pocket costs. Most members dont need a referral from their doctors. The Blue Distinction Specialty Care program recognizes healthcare providers for their quality care and patient results. f. Other duties as assigned. With Diabetes Remote Monitoring, you will receive a free smart glucose meter that synchronizes with your smartphone and securely sends data to specialist pharmacists who are available to support you. Transamerica offers you a choice of medical plans1 with a range of coverage levels and costs, so you have the flexibility to select the option thats best for you. However, only the amount you pay towards your specialty prescriptions will be applied to your deductible and out-of-pocket maximum. HealthPartners insurance plans cover more than 1,000,000 doctors. Strong verbal/written communications skills. Collaborate with testing and system implementations and enhancements. Are there any age restrictions when using Doctor on Demand? a hospital. Kaiser also offers an online chat feature. Primary Care Physicians Effectively builds relationships, influences, and solicits cooperation from others. However, in general, there are no specific age restrictions. 4 years of health care, health insurance, or related industry experience: In a related analytical role e.g., provider payment/ reimbursement, provider compensation, finance, etc. From tracking claims to improving your health, information that puts you in charge of your spending and your well-being is just a click away. Find care in a HealthPartners plan network Choose the doctor, specialist or dentist who's right for you. By logging in, you can be sure you're searching for providers in your plan's network. Please note, Blue Medicare Advantage HMO members must see an in-network dentist to use their dental benefits. Blue Distinction Centers are healthcare facilities and providers recognized for their expertise and efficiency in delivering BeWell 24/7 is here for you, when you need it connecting you with a real person who can help with a variety of health-related concerns. TouchCare also offers a 30-minute consultation during open enrollment. Non-participating providers may charge more for health care than participating providers. Just by being a member, you and your dependents have exclusive, free access to identity protection services called IDX Identity. The cost of prescription drugs is rising faster than many other health care services and supplies. ), A non-physician specialist is a provider who has more training in a specific area of health care. Obtain approval in advance to help prevent delays and unexpected costs. Our solution lets members select a PCP or specialist, view cost estimates from provider profiles, and connect directly to care with telehealth access and online appointment scheduling. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Leading the way in health insurance since 1929. of care evaluation(s) must meet BDC+ national criteria. Log In Page | Wellmark Blue Cross and Blue Shield Login - Wellmark Provides copay assistance toward the purchase of certain specialty medications. It is also your first stop in learning whether an authorization is required. (Note: These programs do not apply to Kaiser plans.). When you are sick and need care quickly, a Virtual Visit is a convenient way to start feeling better faster. Perform data modeling to assist providers understanding of methodology changes/updates. What health plans need to know about recent guidance. If you know about future expenses, or if you want to save for your health care costs in retirement, set aside a little extra each paycheck so your balance can grow over time. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. local BCBS Plan, or visit included with each medical plan. Find Medicare Insurance Plans Shop Individual & Family Plans Member Resources Compare Group Insurance Plans Producer Resources Bettendorf, Grundy Center, Hiawatha receive 2023 Healthy Hometown Powered by Wellmark Community Award 1 of 6 If you or a family member has a medical emergency, getting help right away is the most important thing. For details on a providers in-network status or Proactive self-starter with strong organizational, prioritization and time management skills, as well as excellent attention to detail. If your clinic is closed, you can call the 24/7 HealthPartners CareLine service at 612-339-3663 or 800-551-0859. This level includes providers in Iowa and South Dakota (and a few in surrounding states). Go to the Wellmark Find a Provider page Select "Find a provider or facility." A message will appear letting you know "You are now leaving Wellmark.com" - select "Continue to New Site" Choose a location and plan - ex. Kaiser may be available as a carrier option for participants living in California, Colorado, the District of Columbia, Georgia, Maryland and Virginia. When a provider is non-participating with BCBS, nothing will be covered under Level 3. When you enroll in a Transamerica medical plan, you will automatically receive prescription drug coverage. A high deductible health plan (HDHP) that offers lower premiums and high deductibles, along with a tax-advantaged Health Savings Account (HSA) to put you in charge of your spending. SORRY! With IDX Identity, you can monitor your credit record, keep track of your online The medical Authorization Table is your best resource for viewing medical policies and criteria used by Wellmark. You are skilled at thinking conceptually, anticipating long-term outcomes, and identifying and implementing continuous improvement opportunities around provider reimbursement. Payment is made to you from Wellmark, and you are responsible for paying the provider. To get the most out of your dental plan, make sure your dentist is in the Delta Dental Medicare Advantage network. In the event that you or a covered family member are diagnosed with a health condition that requires complex care, or requires follow-up care after a recent hospital stay, you and your family will receive support from a dedicated team of nurses, clinicians and other specialized professionals to help you improve your health. Blue Cross and Blue Shield have contracts with these providers, and they agree to accept payment arrangements. Health and Wellness. Whether you need help discussing care options, determining if a fever warrants a trip to the doctor or even finding elder care, you can call 24 hours a day, 7 days a week at 844-84-BeWell. e. Configure, transfer and monitor data that is being processed in the provider payment systems. 1Number of medical plan options varies by location and eligibility. If this is your first time visiting the site, take a minute to register (be sure you have your member ID number handy). (scheduled) procedures related to this Blue Distinction Specialty Care program Financial Analyst - Provider Reimbursement in Wellmark, Inc. They would be considered participating with Wellmark BCBS, both the Blue Choice (UIChoice) and the Blue Access (UISelect) network. An individual may choose to have all primary health care provided by faculty members and staff physicians. HealthPartners insurance plans cover more than 1,000,000 doctors. Employees can earn up to $500, and a covered spouse has the opportunity to earn an additional $300. Apply qualitative and quantitative techniques to interpret provider data and provide pricing recommendations as appropriate. Find a doctor, dentist, pharmacy or facility | Wellmark Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Employees covering themselves and child(ren) only can earn up to $800 (only the employee is required to complete the activities). For complete details on coverage and for more information on how to enroll, visit the Mercer Marketplace 365+website. They do not agree to accept payment arrangements and are not responsible for filing claims for you. IOWA Wellmark Blue HMO (Wellmark Health Plan of Iowa) Included Plans Wellmark Blue HMO | UnityPoint (Wellmark Health Plan of Iowa) Included Plans SOUTH DAKOTA Likewise, physician designations may show names of facilities (or other provider You will only be offered Kaiser as a medical option if it is available for your home ZIP code. The following programs are available to those enrolled in a Wellmark BlueCross Blue Shield medical plan: The 2nd.MD program gives you access to board-certified doctors across the country for an expert second opinion, enabling you to connect with a top specialist by video or by phone at a time thats convenient for you. 2023 Mercer Belong, Inc. All rights reserved. If you receive emergency care for covered services and cannot reasonably reach a participating provider, emergency room care received during the emergency will be reimbursed as though the member obtained the services from a participating provider. Select Employer and Individual Plans, followed by Choice Plus.. By agreeing to submit your resume, you consent (in accordance with our Terms of Use and Privacy Policy) to: Should you have any questions or wish have your information removed from our service, please contact us here. activity 24/7, and have access to complete identity recovery if fraudulent activity is found. GreatAmerica Financial Services Corporation, Des Moines, IA, Principal Financial Group, Des Moines, IA. System Error | Wellmark Blue Cross and Blue Shield If you live in Hawaii, you are only eligible for the Platinum Be Fit Plan offered by Kaiser-Hawaii. BDC and BDC+ are displayed on www.bcbs.com. Watch for more information in 2023. If you choose a coverage tier other than Self Only, there is an embedded individual deductible, which means that coinsurance will begin for a covered family member if that persons individual deductible is met; coinsurance begins for all covered family members once the family deductible has been met. If your Kaiser provider determines the care you need can be provided in a video visit, this is a great alternative to making a trip for an in-person visit. You will never forfeit any money left in your HSA, it rolls over year after year. Collaboration is key, so building and maintaining strong business relationships with other Health Network team members at Wellmark will be important to enhance the support we deliver to our providers. Accredo is the specialty pharmacy for United Healthcare and Wellmark Blue Cross Blue Shield plans. You can search by Doctors or Locations, Region or Specific Location, and can search by Hospitals,Specialties, Doctors' Names or Keywords. Even add accurate, flexible, and augmented provider profiles and data to boost satisfaction and go beyond provider data mandate requirements. Blue Distinction Centers+ are healthcare facilities and entities) with which those physicians are affiliated. Level 1 providers under UIChoice include the University of Iowa Hospital and affiliated clinics, UI Urgent Care, UI QuickCare, Washington County Hospitals and Clinics, and The Iowa Clinic in Des Moines. Comunquese al 800-524-9242 o al (TTY: 888-781-4262). Once you enroll for medical coverage, you will receive a prescription drug ID card from Express Scripts or Kaiser Pharmacy within 30 days of enrollment. To support you in living your best life, Transamerica provides valuable benefits that help you and your family stay healthy and pay for care in the event of illness or injury. To find providers designated as Blue Distinction Centers and Blue Distinction Centers+, please note: *Blue Distinction Center designation only. The lower the provider level you visit, thelower out-of-pocket costs for the UISelect member. 5 SIMPLE STEPS TO RECONNECT WITH YOUR HEALTH If you're ready to improve your health and wellness, we have an easy 5-step checklist to help you reach your goals using benefits and resources you already have in your plan. Using in-network providers saves you money. 1With the $900, $3,000 and $4,500 Deductible Plans, coinsurance will begin for a covered family member if that family members individual deductible is met; coinsurance begins for all covered family members once the family deductible has been met. B) Salary.com being able to use your name and address to tailor job posting to your geographic area. Select either "Medical Directory or Behavioral Health Directory as appropriate. Provider Search for Health Plans - HealthSparq Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. MedicareBlue Supplement. Demonstrates ability to anticipate and analyze long-term reimbursement model outcomes. Mayo Clinic may not be at the highest benefit level or participate in every product offering from the health plans listed below. If you choose to use Express Scripts home delivery for your 90-day supply of your maintenance medication, you can either have your doctor send the prescription directly to Express Scripts or use the Express Scripts website to initiate the transfer to home delivery. View and download online provider claim remittances (PCRs) Log in to Provider Portal. Find a Doctor; Member Forms; Prescription Drug Info; Important Things to Know; Get Adobe Reader; Company. Find an In-Network Provider in Iowa and SD | Wellmark Find an in-network health care Provider Notice Regarding Your Rights and Protections Against Surprise Medical Bills Find a health care provider or facility In that case, it is advisable to contact Blue Cross and Blue Shield for assistance in locating the closest participating provider in that country. We have partnered with Express Scripts to offer prescription drug management programs to help you use your prescription drugs safely and effectively, as well as save money. All agents represented by Wellmark on this website are authorized independent agents for Wellmark Blue Cross and Blue Shield and are licensed to sell insurance in their respective states. A Local Blue Plan may require additional Users are 3x more likely to select preferred providers with HealthSparqs guidance-based experience.