Medical Review Nurse Analyst RN Remote Work

Profile

\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
\u003cul\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
\u003c/ul\u003e
\u003cp\u003e\u003cstrong\u003eThis role could be a good fit if you: \u003c/strong\u003e\u003c/p\u003e
\u003cul\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
\u003c/ul\u003e
\u003cp\u003e\u003cstrong\u003eYou\u0026rsquo;ll benefit from this experience by:\u003c/strong\u003e\u003c/p\u003e
\u003cul\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
\u003c/ul\u003e
\u003cp\u003e\u003cstrong\u003eYou need to have: \u003c/strong\u003e\u003c/p\u003e
\u003cul\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
\u003c/ul\u003e
\u003cp\u003e\u003cstrong\u003eWe also prefer:\u003cbr /\u003e\u003c/strong\u003e\u003c/p\u003e
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\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
\u003c/ul\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
\u003cul\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
\u003c/ul\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
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\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
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\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
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\u003cp\u003e\u003cstrong\u003eGovernment 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
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\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
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\u003cp\u003e\u003cstrong\u003eEPIC Specialty Benefits\u003c/strong\u003e\u003c/p\u003e
\u003cp\u003eEPIC Specialty Benefits provides businesses group insurance products that cover:\u003c/p\u003e
\u003cul\u003e
\u003cli\u003eLife\u003c/li\u003e
\u003cli\u003eDisability\u003c/li\u003e
\u003cli\u003eDental\u003c/li\u003e
\u003cli\u003eVision\u003c/li\u003e
\u003cli\u003eVoluntary benefits\u003c/li\u003e
\u003c/ul\u003e
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Company info

Wisconsin Physicians Service Insurance Corporation
Website : http://www.wpsic.com