Senior Nurse Analyst - CERT

WPS Health Solutions; Charlotte (NC); Remote; USD 75,000 - 77,000; Full time

Job summary

A leading health insurer is seeking a Senior Nurse Analyst-CERT to support Medicare compliance efforts. This role focuses on reducing improper payments by educating providers and monitoring documentation standards. Ideal candidates will have a BSN, RN license, and strong analytical skills, with the opportunity for remote work in various states.

Benefits

Remote and hybrid work options available

Performance bonus opportunities

401(k) with matching contributions

Competitive paid time off

Health and dental insurance starting DAY 1

Qualifications

• 3+ years of clinical nursing experience required.
• Active RN license applicable to state of practice.
• Experience in Medicare compliance and documentation review.

Responsibilities

• Monitor CERT review findings and contact providers for documentation issues.
• Educate providers on Medicare compliance and billing requirements.
• Collaborate with resources for widespread education.

Skills

Analytical skills

Communication skills

Technical proficiency

Education

Bachelor's Degree in Nursing (BSN)

Tools

Electronic Health Records (EHR)

Microsoft Office

Job description

Description

The Senior Nurse Analyst-CERT will support WPS' requirements and goals related to the Comprehensive Error Rate Testing (CERT) program established by CMS, to identify and reduce improper payments in the Medicare program. The main objective of this role is to reduce the improper payment rate by monitoring CERT review findings and contacting providers in cases where documentation was not submitted or was insufficient to meet Medicare coverage guidelines. This will include education of providers on Medicare compliance with billing, coding and documentation requirements and collaboration with internal and external resources to develop widespread education.

Salary Range

$75,000 - $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

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

This role is open to 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

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


• Possess strength in defending your decision-making based on your clinical knowledge


• Like working closely with leadership for clinical review of complicated cases to determine potential next steps


• Have experience performing in depth review and analysis of medical documentation for compliance with Medicare requirements


• Are technically strong on computers


• Are self-motivated and work with a great degree of independence


• Have strong verbal and written communication skillsets

Minimum Qualifications

• Bachelor's Degree in Nursing (BSN) or related field


• Active RN license, applicable to state of practice


• 3 or more years of clinical nursing experience

Preferred Qualifications

• Experience with Electronic Health Records (EHR)


• Strong interpersonal and communication skills to provide written/verbal education to internal/external customers


• Familiarity with regulatory standards (e.g., HIPAA, Joint Commission) and healthcare compliance


• Solid knowledge and understanding of medical record documentation practices


• Strong analytical and critical thinking skills, with the ability to interpret complex data and make informed decisions


• Ability to navigate websites for research and extracting necessary reports


• Proficiency in Microsoft Office products (Excel, Word, Outlook)

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer


• 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

Benefits

• Remote and hybrid work options available


• Performance bonus and/or merit increase opportunities


• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your 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)

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 open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique 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.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.