Who We Are
WPS Health Solutions 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 75 years. 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.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom – Awards and Recognition
Role Snapshot
The Senior Nurse Analyst – CERT is a full-time work from home position that will assist in obtaining and reviewing medical documentation for selected claims. Additional details:
- Contact providers via phone to obtain medical documentation in support of the Comprehensive Error Rate Testing (CERT) program which will reduce improper payments in the Medicare Program.
- Perform review of submitted documentation to assure planned services are medically necessary based on Medicare guidelines.
- Educate providers on Medicare documentation requirements and billing via phone or the development of educational articles.
- Collaborate with internal CERT team members, other Medicare contractors or the CERT contractor to provide recommendations for future error rate reduction efforts to meet or exceed Centers for Medicare and Medicaid Services (CMS) goals
- This role entails working on the phone approximately 80% of the time.
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 in a new and different way
- Enjoy being on the phone and talking with provider offices
- Desire day hours with no on-call work and holidays off
- Possess strength in defending your decision making based on your clinical knowledge
- Are technically strong on computers
- Are self-motivated and work with a great degree of independence
- Have strong verbal and written communication skillsets
What will I gain from this role?
- Collaborating with a team of both clinicians and non-clinicians
- Deepening your understanding of Medicare and how the program works
- Learning about our Hyland OnBase tool which is our content management system used for viewing electronic records
- Experience working in an environment that serves our Medicare beneficiaries
- Continuous performance feedback
Minimum Qualifications
- Bachelor’s Degree in related field or equivalent post high school and/or related work experience
- Active RN license, applicable to state of practice
- Fiber or cable high speed internet service (satellite internet or hot spots are NOT acceptable) that meet our remote work requirements including having a designated work station, a wired Ethernet connection (NOT wireless internet) to the network, and a minimum of 10Mbps downstream connection with at least 1Mbps upstream (can be checked at https://speedtest.net). If you do not currently have high speed cable or fiber internet but are able to obtain it prior to the start date, that is acceptable (as long as it meets our upstream and downstream connection requirements previously mentioned).
Preferred Qualifications
- Bachelor’s degree in Nursing
- 4 or more years of experience in clinical nursing
- Experience outside of direct patient care such as utilization management review, or medical records review experience
- Experience with background in Medicare principles and guidelines
- Experience providing written/verbal education to internal/external customers
Remote Work Requirements
- Wired (ethernet cable) internet connection from your router to your computer (add this bullet point only IF your role requires a wired connection)
- High speed cable or fiber internet
- Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
- Please review Remote Worker FAQs for additional information
Salary Range
$75,000 to $77,000
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills and experience.
Work Hours
- This is a full-time salaried position.
- Monday through Friday with some flexibility on the start and end time as long as your 8 hour day falls between 6:00 AM CST and 6:00 PM CST.
Work Location
We are a remote-first organization and offer remote work in the following approved states:
Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin
Benefits
- Remote and hybrid work options available
- Performance bonus and/or merit increase opportunities
- 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
- Competitive paid time off
- Health insurance, dental insurance, and telehealth services start DAY 1
- Employee Resource Groups
- Professional and Leadership Development Programs
- Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml)
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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)