Medical Review Nurse Analyst RN
2 weeks ago
We are seeking a highly skilled Medical Review Nurse Analyst RN to join our team at WPS Health Solutions. As a Medical Review Nurse Analyst RN, you will play a critical role in ensuring that healthcare providers are billing and being paid accurately for services provided to Medicare patients.
About the RoleThe Medical Review Nurse Analyst RN will be responsible for reviewing medical documentation submitted to Medicare to ensure that providers are billing and being paid correctly for services provided. This will involve reviewing claims and delivering provider education to ensure that providers are aware of the correct billing and documentation requirements.
Key Responsibilities- Review medical documentation submitted to Medicare to ensure that providers are billing and being paid correctly for services provided.
- Deliver provider education to ensure that providers are aware of the correct billing and documentation requirements.
- Monitor the progress of assigned providers and educate on current billing and documentation requirements.
- Perform medical documentation reviews.
- Associate or Bachelor 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, 1 or more years of medical claims review experience, experience with Medicare contracts (MAC experience), experience with background in government Medicare principles and guidelines.
- Remote work option available.
- Performance bonus and/or merit increase opportunities.
- 401(k) with dollar-per-dollar match up to 6% of salary.
- Competitive paid time off.
- Health insurance, dental insurance, and telehealth services start DAY 1.
WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. We offer 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.
We are proud of the recognition we have received from local and national organizations regarding our culture and workplace. We are committed to creating an inclusive and empowering employee experience and 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.
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