The Outreach and Education Nurse Analyst will develop and deliver education to providers regarding current and upcoming clinical and billing Medicare regulations. This role utilizes clinical judgment and understanding of Medicare regulations to assist providers in developing best practices to avoid coverage and billing errors to reduce certain error rates and protect the Medicare Trust Fund. In addition, the Outreach and Education Nurse Analyst coordinates with external partners to widen audience, giving rural or remote providers access to critical Medicare program information.
In this role you will:
Track Medicare regulations, WPS policy guidelines, coverage issues, and upcoming legislation, to determine areas providers need additional education.
Anticipate impact of new legislation on provider community and develop timely and appropriate education plans to assist providers.
Coordinate with other Outreach Nurse Analysts and Outreach Analysts to develop an overall plan for clinical education consistent with Medicare Administrative Contractor (MAC) contract obligations, analyzed data, and resources available.
Establish and maintain partnerships with external entities to provide education and assist in dissemination of Medicare provider education materials.
Schedule, promote, manage, and implement local and national provider education using a variety of media, including e-mail, phone, webinars, teleconferences, live seminars, website articles, and computer-based training modules.
Coordinate all aspects of educational events, including venue selection, travel, materials production, registration and payment management, presentation of material, evaluation of event, and analysis of participant feedback.
Function as a clinical resource for Outreach Analysts in Provider Outreach and Education (POE) and other Medicare staff.
Act as a liaison between other WPS GHA Departments, Medical Directors, external partner entities, and external customers.
Help other departments develop internal and external education and ensure compliance with Provider Communications regulations and website development policies.
Analyze geographical data and past provider educational efforts to determine best method of education for a particular region so WPS resources are used in most effective way possible.
Analyze current provider error data from internal and external sources to determine if current educational materials need to be updated or additional education material needs to be developed.
Spearhead both intradepartmental and interdepartmental projects and teams, as well as represent WPS GHA on Centers for Medicare & Medicaid Services (CMS) workgroups and task forces.
Provide support to Unified Program Integrity Contractor, law enforcement, Office of Inspector General, and Government Accountability Office.
Recommend, develop, and implement process changes to maximize use of WPS resources and promote departmental goals.
This role could be a good fit if you:
Want to work 100% remote from the comfort of your home and use your nursing knowledge in a different way
Have the ability to utilize various modes of technology to create on-demand training/learning
Are a creative individual who can develop and present material in a variety of formats (i.e. web, video, teleconference, in-person)
Have strong writing skills to develop content for website articles and on-line learning
Communicate in a way that is clear, articulate, and concise
Don't shy away from speaking in front of large audiences
Are able to commit to regular business travel
Receive and give feedback in a positive way
Possess a research mindset and like digging in to solve complex questions
You'll benefit from this experience by:
Enjoying working remotely with a flexible schedule
Having the freedom to determine education needs and best course of action to deliver
Sharing input with CMS on processes and initiatives with an impact on the Medicare Trust Fund
Working collaboratively with various CMS workgroups to help develop and share information with the Provider community
Traveling occasionally to different areas of the country
Working in an environment that serves our Nation's military, veterans, Guard and Reserves along with their families. In addition, we also serve Medicare beneficiaries and providers.
You need to have:
Registered Nurse license applicable to state of practice
4 or more years clinical nursing experience
Professional writing and presentation experience
Ability to travel 25% of the time approximately April through October each year
We strongly prefer:
MS Office skills in Power Point, Excel, and Word
2 or more years Medical Review Nurse Analyst experience with background in Medicare principles and guidelines
Compensation and Benefits
Eligible for annual Performance Bonus Program
401(k) with dollar-per-dollar match up to 6% of salary
Competitive paid time off
Health and dental insurance start DAY 1
Flexible spending, dependent care, and health savings accounts
Short- and long-term disability, group life insurance
Dress for your day
Innovative professional and cognitive development programs
Who We Are
WPS Health Solutions is an innovator in health insurance and a worldwide leader in claims administration, serving millions of beneficiaries in the United States and abroad.
Founded in 1946, WPS offers health insurance plans for individuals, families, and seniors, and group plans for small and large businesses. We are a world-class claims processor and program administrator for the government's Medicare program. And we manage benefits for millions of active-duty and retired military personnel and their families.
WPS Military and Veterans Health administers claims and provides customer service and related activities for the U.S. Department of Defense and the U.S. Department of Veterans Affairs and their beneficiaries.
WPS Government Health Administrators manages Medicare Part A and Part B benefits for more than 7 million beneficiaries. As one of the largest contractors for the Centers for Medicare & Medicare Services, we've served Medicare beneficiaries and their health care providers since 1966.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)