- 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
- 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
- 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.
- Associate's or Bachelor's Degree in Nursing
- Active RN license, applicable to state of practice
- Bachelor's Degree in Nursing
- 4 or more years of experience in clinical nursing
- Experience with background in government Medicare principles and guidelines
- 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 Remote Worker FAQs for additional information
- Full-Time, Salaried
- Monday through Friday, Day Hours
- 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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Medical Review Nurse Analyst - Madison, WI, United States - WPS
Description
Who We AreWPS 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.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition
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:
$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
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
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR c)
