Medical Review Nurse Specialist

5 days ago

Madison, Wisconsin, United States WPS Inc Full time
Job Title: Medical Review Nurse Analyst

We are seeking a highly skilled Medical Review Nurse Analyst to join our team at WPS Health Solutions. As a Medical Review Nurse Analyst, you will play a critical role in ensuring the accuracy and integrity of Medicare claims.

About the Role

The Medical Review Nurse Analyst will be responsible for reviewing medical documentation submitted to Medicare to ensure that providers are billing and being paid appropriately for services provided based on Medicare guidelines. This role requires strong clinical knowledge, analytical skills, and excellent communication skills.

Key Responsibilities
  • Review medical documentation to ensure compliance with Medicare guidelines
  • Provide education to providers on billing and documentation requirements
  • Monitor the progress of assigned providers and educate on current billing and documentation requirements
  • Perform medical documentation reviews
Requirements

To be successful in this role, you will need:

  • An Associate or Bachelor's Degree in Nursing
  • An active RN license, applicable to the state of practice
  • 4 or more years of experience in clinical nursing
  • 1 or more years of medical claims review experience
What We Offer

We offer a competitive salary range of $66,000 to $70,000 annually, as well as a range of benefits, including:

  • 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
About WPS Health Solutions

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 our culture and workplace, which is recognized by local and national organizations for its inclusivity, empowerment, and diversity. We are committed to making healthcare easier for the people we serve.

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