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Medical Review Nurse Analyst

Company: Wisconsin Physicians Service Insurance Corporation
Location: Rothschild
Posted on: June 12, 2021

Job Description:

Role Summary: The Medical Review Nurse Analyst will assist in reviewing medical documentation to assure billing providers are billing and being paid appropriately for services provided based on Medicare guidelines.

In this role you will:

  • 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 the provider on documentation requirements for services rendered
  • Perform post-pay Probe reviews
  • Perform prepay Targeted Medical Reviews

This role could be a good fit if you:

  • Are looking to move away from direct patient care and want to use your nursing knowledge in a new and different way
  • Desire day hours with no on-call work, limited weekend work, and enjoy holidays off
  • Have strong verbal and written communication
  • Possess strength in defending your decision making based on your clinical knowledge
  • Enjoy teaching and training providers
  • Are technically strong on computers
  • Are self-motivated and work with a great degree of independence
  • Have the ability to multitask, set priorities and excel at time management
  • Enjoy process improvement

You'll benefit from this experience by:

  • Collaborating with a team of both clinicians and non-clinicians
  • Understanding Medicare and how the program works
  • Serving Medicare and educating providers within the WPS jurisdictions
  • Staying connected with providers
  • Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records

You need to have:

  • Associate's degree in Nursing
  • Active RN license, applicable to state of practice
  • Four years or more of experience in clinical nursing

We also prefer:

  • Bachelor's degree in Nursing and/or related field
  • Experience with background in Medicare principles and guidelines

Your team: This team is comprised of clinical and operational staff

Compensation and Benefits

  • Eligible for annual Performance Bonus Program
  • 401(k) with dollar-per-dollar match up to 6% of salary
  • Competitive paid time off
  • Health and dental insurance start DAY 1
  • Vision insurance
  • Flexible spending, dependent care, and health savings accounts
  • Short- and long-term disability, group life insurance
  • Dress for your day
  • Innovative professional and cognitive development programs

Who We Are

WPS 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.

Founded 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's Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.

Learn more about WPS.

Our Purpose and Values

Our purpose is to make healthcare easier for those we serve. Click Here

Our values - Customer Focused, Individual Responsibility, Mutual Respect, and Driven & Passionate - are the core of who we are and how we conduct business every day.

WPS Health Insurance

WPS 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.

Military and Veterans Health

WPS 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.

Government Health Administrators

WPS 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 & Medicare Services, we've served Medicare beneficiaries and their health care providers since 1966.

WPS Health Plan

WPS 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.

EPIC Specialty Benefits

EPIC Specialty Benefits provides businesses group insurance products that cover:

  • Life
  • Disability
  • Dental
  • Vision
  • Voluntary benefits

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Keywords: Wisconsin Physicians Service Insurance Corporation, Green Bay , Medical Review Nurse Analyst, Other , Rothschild, Wisconsin

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