Medical Review Nurse Analyst (RN)

Who We Are WPS Health Solutions is a leading not-for-profit health insurer in Wisconsin.

Our services offer health insurance plans for individuals, families, seniors, and group plans for small to large businesses.

We process claims and provide customer service 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.

In 2021, WPS Health Solutions celebrates 75 years of making health insurance easier for those we serve.

Proud to be military and veteran ready.

Our Culture WPS’ Performance-Based Culture is where the great work and innovations of our people are seen, fueled, and rewarded.

We accomplish this by creating an inclusive, empowering employee experience, focusing on People, Work, and Conditions.

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 guided by our Purpose: Together, making health care easier for the people we serve.

In 2021, WPS Health Solutions was recognized for several awards including: Madison, Wisconsin’s Top Workplaces Top Workplace national cultural excellence awards for Remote Work and Work-Life Flexibility Achievers 50 Most Engaged Workplaces® with the further honor of Achievers “Elite 8” winner in the category of Culture Alignment 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, limited weekend work, and holidays off Collaborating with a team of both clinicians and non-clinicians Deepening your understanding of Medicare and how the program works Serving Medicare and educating providers within WPS jurisdictions Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records Minimum Qualifications COVID-19 vaccination or WPS approval for an accommodation.

Bachelor’s Degree in related field or equivalent post high school and/or related work experience 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 Medicare principles and guidelines Benefits Remote and hybrid work options 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, dental insurance, Teladoc starts DAY 1 Review additional benefits here Sign up for Job Alerts FOLLOW US LinkedIn Facebook Twitter