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Job Details

Medical Review Nurse Analyst RN Remote Work

Company name
Wisconsin Physicians Service Insurance Corporation

, AZ, United States

Employment Type

Healthcare, Nursing, Insurance

Posted on
Sep 14, 2021

Valid Through
Dec 28, 2021

Apply for this job


\u003cp\u003e\u003cstrong\u003eRole Summary:\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cem\u003eAre you considering a career move away from direct patient care and want to use your nursing knowledge in a new and different way? If you desire a remote nursing position with daytime hours and no on-call work this position may be for you!\u003c/em\u003e\u003c/p\u003e
\u003cp\u003eThe Medical Review Nurse Analyst will review medical documentation for post pay claims submitted to Medicare to ensure providers are billing and being paid appropriately for services provided based on Medicare guidelines, specifically for beneficiaries eligible for both Medicare and Medicaid. The Medical Review Nurse Analyst will review claims and deliver provider education as warranted. \u0026nbsp;\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003eIn this role you will:\u003c/strong\u003e\u003c/p\u003e
\u003cli\u003eReach out to and educate providers in accordance with the Targeted Probe and Educate (TPE) program.\u003c/li\u003e
\u003cli\u003ePerform review of submitted claims to ensure billed services are medically necessary and correctly coded based on Medicare guidelines\u003c/li\u003e
\u003cli\u003eMonitor 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\u003c/li\u003e
\u003cli\u003eEducate providers on documentation requirements for services rendered\u003c/li\u003e
\u003cli\u003ePerform post-pay medical documentation reviews\u003c/li\u003e
\u003cp\u003e\u003cstrong\u003eThis role could be a good fit if you: \u003c/strong\u003e\u003c/p\u003e
\u003cli\u003eAre looking to move away from direct patient care and want to use your nursing knowledge to help patients in a new and different way\u003c/li\u003e
\u003cli\u003eHave the ability to transform sensitive situations into teachable opportunities for future success\u003c/li\u003e
\u003cli\u003ePossess strength in defending your decision-making based on your clinical knowledge\u003c/li\u003e
\u003cli\u003eEnjoy educating providers\u003c/li\u003e
\u003cli\u003eAre technically strong on computers\u003c/li\u003e
\u003cli\u003eAre self-motivated and work with a great degree of independence\u003c/li\u003e
\u003cli\u003eHave strong verbal and written communication\u003c/li\u003e
\u003cp\u003e\u003cstrong\u003eYou\u0026rsquo;ll benefit from this experience by:\u003c/strong\u003e\u003c/p\u003e
\u003cli\u003eEnjoying a work from home position with daytime hours, no on-call work, limited weekend work, and holidays off\u003c/li\u003e
\u003cli\u003eCollaborating with a team of both clinicians and non-clinicians\u003c/li\u003e
\u003cli\u003eDeepening your understanding of Medicare and how the program works\u003c/li\u003e
\u003cli\u003eServing Medicare and educating providers within WPS jurisdictions\u003c/li\u003e
\u003cli\u003eLearning about our Hyland OnBase tool which is our content management system used for viewing electronic records\u003c/li\u003e
\u003cp\u003e\u003cstrong\u003eYou need to have: \u003c/strong\u003e\u003c/p\u003e
\u003cli\u003eAssociate\u0026rsquo;s degree in Nursing or equivalent\u003c/li\u003e
\u003cli\u003eActive RN license, applicable to state of practice\u003c/li\u003e
\u003cp\u003e\u003cstrong\u003eWe also prefer:\u003cbr /\u003e\u003c/strong\u003e\u003c/p\u003e
\u003cli\u003eBachelor\u0026rsquo;s degree in Nursing and/or related field\u003c/li\u003e
\u003cli\u003e4 or more years of experience in clinical nursing\u003c/li\u003e
\u003cli\u003eExperience with background in Medicare principles and guidelines\u003c/li\u003e
\u003cp\u003e\u003cstrong\u003eYour team: \u003c/strong\u003e\u0026nbsp;\u003c/p\u003e
\u003cp\u003eThis team is comprised of clinical and operational staff\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003eCompensation and Benefits\u003c/strong\u003e\u003c/p\u003e
\u003cli\u003eEligible for annual Performance Bonus Program\u003c/li\u003e
\u003cli\u003e401(k) with \u003cstrong\u003edollar-per-dollar match up to 6% of salary\u003c/strong\u003e\u003c/li\u003e
\u003cli\u003eCompetitive paid time off\u003c/li\u003e
\u003cli\u003eHealth and dental insurance start \u003cstrong\u003eDAY 1\u003c/strong\u003e\u003c/li\u003e
\u003cli\u003eVision insurance\u003c/li\u003e
\u003cli\u003eFlexible spending, dependent care, and health savings accounts\u003c/li\u003e
\u003cli\u003eShort- and long-term disability, group life insurance\u003c/li\u003e
\u003cli\u003eDress for your day\u003c/li\u003e
\u003cli\u003eInnovative professional and cognitive development programs\u003c/li\u003e
\u003cp\u003e\u003cstrong\u003eWho We Are\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eWPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.\u003c/p\u003e
\u003cp\u003eFounded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government\u0026rsquo;s Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.\u003c/p\u003e
\u003cp\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003cstrong\u003eLearn more about WPS\u003c/strong\u003e\u003c/a\u003e\u003cstrong\u003e. \u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003eOur Purpose and Values\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eOur purpose is to make healthcare easier for those we serve. \u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003cstrong\u003eClick Here\u003c/strong\u003e\u003c/a\u003e\u003c/p\u003e
\u003cp\u003eOur values \u0026ndash; Customer Focused, Individual Responsibility, Mutual Respect, and Driven \u0026amp; Passionate \u0026ndash; are the core of who we are and how we conduct business every day.\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003eWPS Health Insurance\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eWPS Health Insurance offers high-quality health insurance plans for individuals and families, Medicare supplement plans for seniors, and group health plans for businesses of every size.\u003c/p\u003e
\u003cp\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003c/a\u003e\u003c/p\u003e
and Veterans Health\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eWPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.\u003c/p\u003e
\u003cp\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003c/a\u003e\u003c/p\u003e
Health Administrators \u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eWPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare \u0026amp; Medicare Services, we\u0026rsquo;ve served Medicare beneficiaries and their health care providers since 1966.\u003c/p\u003e
\u003cp\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003c/a\u003e\u003c/p\u003e
Health Plan\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eWPS Health Plan offers Health Maintenance Organization and Point-of-Service plans to the group and individual markets in eastern and north-central Wisconsin, plus third-party administrator services.\u003c/p\u003e
\u003cp\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003c/a\u003e\u003c/p\u003e
Specialty Benefits\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eEPIC Specialty Benefits provides businesses group insurance products that cover:\u003c/p\u003e
\u003cli\u003eVoluntary benefits\u003c/li\u003e
\u003cp\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003c/a\u003e\u003c/p\u003e
connected:\u0026nbsp;\u003c/strong\u003e\u003ca href=\u0022\u0026amp;redirectUrl=/WIS1003/JobBoard/e6da0c90-f987-63dc-99a9-fb8c9014f57e/JobSearchAgent\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003e\u003cstrong\u003eSign up for Job Alerts\u003c/strong\u003e\u003c/a\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003eFOLLOW US!\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eFacebook\u003c/a\u003e\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eTwitter\u003c/a\u003e\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003e\u003cstrong\u003e\u003ca href=\u0022\u0022 target=\u0022_blank\u0022 rel=\u0022noopener\u0022\u003eLinkedIn\u003c/a\u003e\u003c/strong\u003e\u003c/p\u003e,EqualOpportunityEmployerDescription:Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities,PayTransparencyPolicyStatement: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 60-1.35(c),MatchScore:1.0,HasApplied:false,ApplicationJobBoardName:null,ApplicationJobBoardId:null,DateApplied:null,Salaried:true,CompensationAmount:null,PublishingStatus:1,Links:[],BehaviorCriteria:[],MotivationCriteria:[],EducationCriteria:[],LicenseAndCertificationCriteria:[],SkillCriteria:[],WorkExperienceCriteria:[],JobBoardMemberships:[{JobBoardId:cdefa8ae-f907-5c13-2775-f0106d0aa34a,PublishedInternal:true,PublishedExternal:false,ExternalPostedDate:null,InternalPostedDate:2021-09-14T16:19:59.427Z},{JobBoardId:e6da0c90-f987-63dc-99a9-fb8c9014f57e,PublishedInternal:false,PublishedExternal:true,ExternalPostedDate:2021-09-14T16:20:09.175Z,InternalPostedDate:null}],AssessmentUri:null,AssessmentStatus:null,OpportunityIsClosed:false,TravelRequired:null,TravelDescription:null,SupervisorName:null,Assessments:[],ApplicationId:null,CompensationAnnualMinimum:null,CompensationAnnualMaximum:null,CompensationHourlyMinimum:null,CompensationHourlyMaximum:null,CompensationCurrency:null});

Company info

Wisconsin Physicians Service Insurance Corporation
Website :

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