Description 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