Medical Review Nurse Analyst
- Wisconsin Physicians Service Insurance Corp
- Grove City, Ohio
- Full Time
The Medical Review Nurse Analyst is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This role ensures that providers are billing and being paid appropriately for services provided based on Medicare guidelines. The Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements.
Salary Range
$66,000 - $70,000
The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
Work Location
We are 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? You'll be:
Reviewing submitted claims to ensure that billed services are medically necessary and correctly coded based on Medicare guidelines.
Preparing written clinical summaries and determinations with clear rationale for approvals, denials, or modifications.
Educating providers in accordance with the Targeted Probe and Educate (TPE) program.
Monitoring the progress of assigned providers and educate on current billing and documentation requirements.
Ensuring compliance with federal and state regulations, CMS guidelines, and company policies.
Staying current on clinical guidelines, medical policy updates, and industry best practices.
What will I gain from this role?
Enjoying a work from home position with daytime hours, no on-call work, no travel, and holidays off
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 Nation's military, veterans, Guard and Reserves and Medicare beneficiaries
Working in a continuous performance feedback environment
Minimum Qualifications
Associate's Degree in Nursing (ASN) or Bachelor's Degree in Nursing (BSN).
Active RN license, applicable to state of practice in good standing.
1 or more years of clinical experience in a healthcare setting.
Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
Strong attention to detail and organizational skills to manage multiple cases simultaneously.
Basic knowledge and understanding of medical/clinical review processes.
Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel.
Preferred Qualifications
Experience working for a Medicare Administrative Contractor (MAC).
Basic Medicare knowledge and/or experience.
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
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: (
Job ID: 484683996
Originally Posted on: 7/10/2025
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