Medical Review Nurse Analyst (RN) - REMOTE

Who We Are

WPS Health Solutions 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 75 years. 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.

From 2021 to 2023, WPS Health Solutions was recognized for several awards:

• Madison, Wisconsin’s Top Workplaces
• USA Top Workplaces and the 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
• DAV Patriot Employer
• VETS Indexes 4 Star Employer
• BBB Torch Award for Ethics from Better Business Bureau of Wisconsin

Role Snapshot

Education

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 https://speedtest.net)
• Please review Remote Worker FAQs 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 **

Benefits**

• 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 Resource Groups
• Professional and Leadership Development Programs
• Review additional benefits here

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