Wisconsin Licensed Medical Review Nurse

Job Summary

To ensure compliance with regulatory and payer guidelines, the full-time Wisconsin Licensed Medical Review Nurse Analyst will conduct clinical reviews of medical records, review claims for appropriate reimbursement, and provide education to providers on billing and documentation requirements, with the option for remote work in approved states.

Key responsibilities

• Conduct detailed reviews of medical records to assess the medical necessity of services
• Review submitted claims to ensure correct coding and compliance with Medicare guidelines
• Educate providers on billing and documentation requirements in accordance with the Targeted Probe and Educate (TPE) program

Required qualifications

• Associate's (ASN) or Bachelor's Degree in Nursing (BSN)
• Active RN license in good standing applicable to the state of practice
• 1 or more years of clinical experience in a healthcare setting
• Basic knowledge of medical/clinical review processes
• Solid computer skills with experience in MS Outlook, Teams, OneNote, Word, and Excel