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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.