WI3656585

1

Vocational Degree

Associate Degree

Unspecified

40

JOB REQUIREMENTS: Description Who We Are 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. WPS Health
Solutions has been making health care easier for the people we serve for
more than . Proud to be military and veteran ready. 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 2024, WPS Health
Solutions was recognized for several awards: Role Snapshot our 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. This 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 to 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\... For full info follow application link. Wisconsin
Physicians Service Insurance Corporation is an Equal Opportunity
Employer/Protected Veterans/Individuals with Disabilities employer.
\*\*\*\*\* APPLICATION INSTRUCTIONS: Apply Online:
ipc.us/t/D14111E264E94D5C Qualified females, minorities, and special
disabled veterans and other veterans are encouraged to apply.