Senior Nurse Analyst - CERT

WPS—A health solutions company; Michigan; Remote; USD 75,000 - 77,000; Full time

Job summary

WPS Health Solutions is seeking a Senior Nurse Analyst to support its CERT program aimed at reducing Medicare's improper payments. This role involves educating providers, analyzing clinical data, and ensuring compliance with regulations. Candidates should possess a BSN, an active RN license, and relevant clinical experience. Remote work options are available for qualified candidates in several states, including Michigan.

Benefits

Remote and hybrid work options available

Performance bonus opportunities

401(k) with match

Competitive paid time off

Health insurance starts DAY 1

Qualifications

• Active RN license, applicable to the state of practice.
• 3 or more years of clinical nursing experience.

Responsibilities

• Support Comprehensive Error Rate Testing (CERT) program requirements.
• Educate providers on Medicare compliance with billing and documentation.

Skills

Communication skills

Analytical skills

Education

Bachelor’s Degree in Nursing (BSN)

Tools

Electronic Health Records (EHR)

Microsoft Office

Job description

Join to apply for the Senior Nurse Analyst - CERT role at WPS—A health solutions company

5 days ago Be among the first 25 applicants

Join to apply for the Senior Nurse Analyst - CERT role at WPS—A health solutions company

Get AI-powered advice on this job and more exclusive features.

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.

Sign up for Job Alerts

FOLLOW US!

Instagram

LinkedIn

Facebook

WPS Health Blog

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

Referrals increase your chances of interviewing at WPS—A health solutions company by 2x

Sign in to set job alerts for “Senior Nurse” roles.

Marquette, MI $2,121.60-$2,121.60 13 hours ago

Registered Nurse Home Health Clinical Manager

EMR Applications Trainer (Clinical Training Experience Required) - REMOTE

West Bloomfield Township, MI 14 hours ago

In-Home Oversight Registered Nurse - As Needed

Travel Nurse RN - Wound Care - $2,162 per week

Registered Nurse - RN / Medical Surgical Floor - M/S

In-Home Oversight Registered Nurse - As Needed

Travel Cardiac Catheterization Lab Registered Nurse - $2,768 per week

Marquette, MI $2,767.40-$2,767.40 1 day ago

Registered Nurse - RN / Operating Room Open Heart - OR-OH

Travel Nurse RN - Wound Care - $2,102 per week

LPN or RN Skilled Visits (Servicing Ingham County)

Registered Nurse - Surgery Clinic Nurse Manager

1st and 3rd Shift Licensed Practical Nurse or Registered Nurse- PEDIATRICS

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.