Medical Review Nurse Analyst (RN) - REMOTE

at WPS Health Solutions in Marion, Illinois, United States

Job Description


Who We Are
is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than . Proud to be military and veteran ready.
Culture Drives Our Success
WPS' Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both current and future-to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace:
Role Snapshot
The Medical Review Nurse Analyst is a work from home position that will review medical documentation submitted to Medicare to ensure providers are billing and being paid appropriately for services provided based on Medicare guidelines. The Medical Review Nurse Analyst will review claims and deliver provider education. Additional details:
Reach out to and educate providers in accordance with the Targeted Probe and Educate (TPE) program.
Perform review of submitted claims to ensure billed services are medically necessary and correctly coded based on Medicare guidelines
Monitor the progress of assigned providers and educate on current billing and documentation requirements. Through review, ensure Medicare providers are correctly reimbursed when documentation supports services rendered
Educate providers on documentation requirements for services rendered
Perform medical documentation reviews
How do I know this opportunity is right for me? If you:
Are looking to move away from direct patient care and want to use your nursing knowledge to help patients in a new and different way
Have the ability to transform sensitive situations into teachable opportunities
Possess strength in defending your decision-making based on your clinical knowledge
Enjoy educating providers
Are technically strong on computers
Are self-motivated and work with a great degree of independence
Have strong verbal and written communication
What will I gain from this role?
Enjoying a work from home position with daytime hours, no on-call work, no travel, and holidays off
Collaborating with a team of both clinicians and non-clinicians
Deepening your understanding of Medicare and how the program works
Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records
Experience working in an environment that serves our Nation's military, veterans, Guard and Reserves and Medicare beneficiaries
Working in a continuous performance feedback environment.
Minimum Qualifications
Associate's or Bachelor's Degree in Nursing
Active RN license, applicable to state of practice
Preferred Qualifications
Bachelor's Degree in Nursing
4 or more years of experience in clinical nursing
Experience with background in government Medicare principles and guidelines
Remote Work Requirements
Wired (ethernet cable) internet connection from your router to your computer
High speed cable or fiber internet
Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at )
Please review for additional information
Salary Range
$68,000 to $70,000 annually
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.
Work Schedule
Full-Time, Salaried
Monday through Friday, Day Hours
Work Location
We are a remote-first organization and offer remote work in the following approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin
Remote work option available
Performance bonus and/or merit increase opportunities
401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
Competitive paid time off
Health insurance, dental insurance, and telehealth services start DAY 1
Employee... For full info follow application link.

Wisconsin Physicians Service Insurance Corporation is an Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities employer.

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Job Posting: 11885846

Posted On: May 14, 2024

Updated On: May 27, 2024

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