Ryan Gansen Email & Phone Number

Ankeny, Ia, Us

Certified Revenue Cycle Specialist

*Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing* Review and price contract related pends to ensure claims payment accuracy*Ensure accure contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (i.e. RHCs/FQHCs/fee schedule updates)*Troubleshoot and problem solve contract implementation issues related to basic system configuration*Review contracts and assign pay classes and applicable provider information based on contract language. If configuration is needed to accommodate a contract, notify the appropriate parties*Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments*Review new and current provider contracts and establish state guidelines*Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff

Develop and implement coding logic for use in automated adjudication, representing all business regulations, processes, and rules that apply to plan designs sold to our customers; Analyze highly customized and complex benefit designs and determine when tables need to be updated and/or created by leveraging warehouse claims data and other internal resources; Work with model office staff to develop test case schematics to verify accuracy of processing outcomes; Provide support and feedback to Sales, Marketing, Product Development, and Actuarial staff regarding Wellmark products, coding rules and logic, benefit designs, and regulatory requirements.

Analyzed claim information and determined appropriate settlement amounts; Managed prior commercial credit communications and applied qualifying carryover benefits for new employer groups; Coordinated benefits with various providers; Identified processing errors and initiated adjustments; Managed HMO plans by working with Enrollment team to ensure members have a Primary Care Physician selected; Adjusted claims as necessary.