Medical Review Nurse Analyst (RN) - REMOTE ID-11008

December 3, 2024

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.

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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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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

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The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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