customer service rep - work at home in ne

registered nurse

medical review nurse analyst

WPS—A health solutions company

<div>
 Our
 
 Medical Review Nurse Analyst
 
 is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This analyst ensures that providers are being reimbursed appropriately for services provided based on Medicare guidelines. This
 
 Medical Review Nurse Analyst
 
 reviews claims and delivers provider education on current billing and documentation requirements.
 
 
 
 Salary Range
 
 
 
 
 $68,000 - $70,000
 
 
 
 
 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience.
 
 
 
 
 Remote Work Location
 
 
 
 
 We are open to remote work in the following approved states:
 
 
 
 Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
 
 
 
 How do I know this opportunity is right for me? If you:
 
 
 
 <ul>
 <li>
 Can perform detailed reviews of medical records and documentation to determine the medical necessity of services.
 </li>
 <li>
 Would enjoy reviewing submitted claims to ensure that billed services are medically necessary and correctly coded based on Medicare guidelines.
 </li>
 <li>
 Want to ensure Medicare providers are correctly reimbursed when documentation supports services rendered.
 </li>
 <li>
 Have prepared written clinical summaries and determinations with clear rationale for approvals, denials, or modifications.
 </li>
 <li>
 Would like to educate providers in accordance with the Targeted Probe and Educate (TPE) program.
 </li>
 <li>
 Can monitor the progress of assigned providers and educate on current billing and documentation requirements.
 </li>
 <li>
 Want to ensure compliance with federal and state regulations, CMS guidelines, and company policies.
 </li>
 <li>
 Enjoy staying current on clinical guidelines, medical policy updates, and industry best practices.
 
 
 </li>
 </ul>
 
 Minimum Qualifications
 
 
 
 <ul>
 <li>
 Associate&rsquo;s (ASN) or Bachelor&rsquo;s Degree in Nursing (BSN).
 </li>
 <li>
 Active RN license, applicable to state of practice in good standing.
 </li>
 <li>
 1 or more years of clinical experience in a healthcare setting (hospital, homecare, skilled nursing, etc.).
 </li>
 <li>
 Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely.
 </li>
 <li>
 Strong attention to detail and organizational skills to manage multiple cases simultaneously.
 </li>
 <li>
 Basic knowledge and understanding of medical/clinical review processes.
 </li>
 <li>
 Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel.
 
 
 </li>
 </ul>
 
 Preferred Qualifications
 
 
 
 <ul>
 <li>
 Experience working for a Medicare Administrative Contractor (MAC).
 </li>
 <li>
 Familiarity with Medicare guidelines and reimbursement processes.
 </li>
 <li>
 Experience with medical record review or utilization review.
 
 
 </li>
 </ul>
 
 Remote Work Requirements
 
 
 
 <ul>
 <li>
 Wired (ethernet cable) internet connection from your router to your computer
 </li>
 <li>
 High speed cable or fiber internet
 </li>
 <li>
 Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
 </li>
 <li>
 Please review Remote Worker FAQs for additional information
 
 
 </li>
 </ul>
 
 Benefits
 
 
 
 <ul>
 <li>
 Remote work options available
 </li>
 <li>
 Performance bonus and/or merit increase opportunities
 </li>
 <li>
 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)
 </li>
 <li>
 Competitive paid time off
 </li>
 <li>
 Health insurance, dental insurance, and telehealth services start DAY 1
 </li>
 <li>
 Professional and Leadership Development Programs
 </li>
 <li>
 Review additional benefits: (https://www.wpshealthsolutions.com/careers/)
 
 
 </li>
 </ul>
 
 Who We Are
 
 
 
 WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, 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 has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
 
 
 
 Culture Drives Our Success
 
 
 
 WPS&rsquo; 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&mdash;both current and future&mdash;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
 
 
 
 This position supports services under Centers for Medicare &amp; Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation including fingerprinting prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services
</div>

Medical Review Nurse Analyst

DataAnnotation

<div>
 We are looking for a Registered Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 This is a full-time or part-time REMOTE position
 </li>
 <li>
 You&rsquo;ll be able to choose which projects you want to work on
 </li>
 <li>
 You can work on your own schedule
 </li>
 <li>
 Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in progress medical degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contract position.
 
 
 #medicine
</div>

Registered Nurse

Douglas County, Nebraska

<div>
 
 
 The Position
 
 
 
 
 Incumbent works under the direction of the Psychiatric Outpatient Program (POP) Program Manager or designee, performing medical assistant and clerical duties for patients eligible to receive services in the Outpatient Clinic.
 
 
 
 Essential Functions
 
 
 
 <ul>
 <li>
 Assist in providing patient treatment in strict adherence to established procedures and regulations.
 </li>
 <li>
 Establish and maintain effective work relationships with clients, supervisors, County employees, elected officials, attorneys, law enforcement, judges, other agencies, and the public.
 </li>
 <li>
 Comply with Civil Service policies and regulations, collective bargaining agreements, County policies, department policies and laws to create a cooperative, safe, respectful and quality work environment.
 </li>
 <li>
 Escort patients to exam rooms, performing and recording screening procedures (e.g. height, weight, blood pressure, vital signs, urinalysis).
 </li>
 <li>
 Prepare patients for appointment, informing the clinic nurse or physician of pertinent information obtained during the screening procedures.
 </li>
 <li>
 Assist during appointment and treatment procedures.
 </li>
 <li>
 Perform venipuncture procedures.
 </li>
 <li>
 Prepare samples and specimens with strict adherence to established safety regulations.
 </li>
 <li>
 Prepare medication refill requests for medical provider authorization, forwarding refill authorizations to the pharmacy.
 </li>
 <li>
 Comply with CMHC standards and accreditation, and state and federal laws and regulations.
 </li>
 <li>
 Answer calls, greeting patients and scheduling clinic appointments.
 </li>
 <li>
 Update and maintain medical records and electronic health records.
 </li>
 <li>
 Requisition supplies and work orders.
 </li>
 <li>
 Follow universal safety precautions, protecting self and patients.
 </li>
 <li>
 Crosstrain with other CMHC programs and provide program services.
 </li>
 <li>
 Triage potential patients requesting outpatient clinic services.
 </li>
 <li>
 Attend to client service requests, maintaining productivity.
 </li>
 <li>
 Recognize CMHC provides services to trauma experienced individuals.
 </li>
 <li>
 Attend staff meetings.
 </li>
 <li>
 Provide and promote a positive image of CMHC.
 </li>
 <li>
 Report to assigned work location with regular, consistent attendance.
 </li>
 <li>
 Perform other duties as assigned and directed.
 
 
 
 </li>
 </ul>
 
 Education And Work Experience And Other Requirements
 
 
 
 <ul>
 <li>
 High school graduation or equivalent required.*
 </li>
 <li>
 One (1) year of relevant experience required.*
 </li>
 <li>
 Current completion of nationally recognized Medical Assistant Program AND Current nationally recognized Medical Assistant Certification or able to obtain within six (6) months of hire and maintained through employment required.
 </li>
 <li>
 Current Medication Aide Certification and maintained through employment required.
 </li>
 <li>
 Current Cardiopulmonary Resuscitation (CPR), first aid and Crisis Prevention Intervention (CPI) within 6 months of hire required.
 </li>
 <li>
 Clerical experience in a healthcare setting preferred.
 </li>
 <li>
 Experience working in behavioral health preferred.
 </li>
 <li>
 Completion of a pre-employment criminal record check and conditional offer drug screen required.
 </li>
 <li>
 *Equivalent combination of work experience and education may be substituted for requirements on a year-for-year basis.
 
 
 
 </li>
 </ul>
 
 
 Physical Requirements &amp; Working Conditions
 
 
 
 
 <ul>
 <li>
 The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 </li>
 <li>
 Work is generally performed in an office setting. Noise level is usually moderate. Work hours are typically standard day-shift hours; however, schedule may vary (e.g. days, hours, overtime/extra hours). Work involves potential exposure to biohazards and risk for injury. Work may be stressful when dealing with time constraints, multiple/changing priorities, limited resources and uncooperative/irate individuals.
 </li>
 <li>
 Work requires some physical activity, including extended periods of walking, standing, frequent reaching, and occasional climbing, balancing, kneeling, crouching and bending. Work also requires the ability to frequently lift and/or carry objects up to 10 pounds and occasionally up to 25 pounds.
 </li>
 <li>
 Required sensory abilities include vision, hearing and touch. Visual abilities, correctable to normal ranges, include close, distance and color vision, depth perception, and the ability to adjust focus. Communication abilities include the ability to talk and hear within normal ranges. Incumbent must possess the hand-eye coordination and manual dexterity necessary to operate computers and other equipment.
 
 
 
 </li>
 </ul>
 Douglas County is an EOE - Disability/Veterans
</div>

Behavioral Health Medical Assistant

<div>
 We are looking for a
 
 Clinical Pharmacist
 
 to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 In this role, you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include Clinical Documentation &amp; HIM, Medication Management (PharmD), Laboratory Medicine and Pathology Services (MLS, MD), Quality Improvement &amp; Patient Safety, Regulatory Compliance, Accreditation &amp; Medical Staff, Care Coordination &amp; Case Management, Population Health &amp; Value-Based Care, and Managed Care &amp; Utilization Management.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 Full-time or part-time remote position
 </li>
 <li>
 Choose which projects you want to work on
 </li>
 <li>
 Flexible schedule
 </li>
 <li>
 Projects are paid hourly starting at $50+ per hour
 </li>
 <li>
 Bonuses available for high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Provide AI chatbots with diverse and complex healthcare-related problems
 </li>
 <li>
 Evaluate AI outputs for logic, accuracy, and performance
 </li>
 <li>
 Ensure the medical accuracy and overall quality of model responses
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in-progress medical or healthcare-related degree
 
 
 </li>
 </ul>
 
 Notes:
 
 Payment is made via PayPal. We will never ask you for any money. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contractor position.
 
 
 
 #medicine
 
</div>

Clinical Pharmacist

Blue Cross and Blue Shield of Nebraska

<div>
 At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.
 
 
 Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there&rsquo;s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you&rsquo;ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.
 
 
 As a Customer Service Representative you are responsible for handling incoming phone calls and being the primary customer interface for inquiries. Our service representatives inform and educate as well as serve as member advocate, building trust in our abilities and being the voice of the customer. By using established best practices, attending ongoing training and utilizing resources and tools you will serve as the expert to help navigate through the challenging world of insurance. Our representatives must be talented dedicated people who possess a passion for providing best in class service and want to make a difference in the lives of our member.
 
 
 <ul>
 <li>
 Candidates applying to this position must reside within the state of Nebraska or immediate Omaha metro at the time of application.
 </li>
 <li>
 Candidate must have distraction free environment in order to take back-to-back calls throughout the day and possess high speed internet.
 </li>
 <li>
 Pay for this position is an annual salary of $42,640
 </li>
 <li>
 Training for this position is remote and lasts approximately 9-12 weeks long (Monday - Friday from 8:00am - 4:30pm CST).
 </li>
 <li>
 After training is completed - all employees must be able to work any 8.5-hour shift Monday - Friday within the hours of 7:30am - 6:00pm CST.
 
 
 </li>
 </ul>
 
 Customer Services hires for classes and we anticipated class start dates:
 
 
 
 <ul>
 <li>
 Summer 2026 &amp; Fall 2026
 </li>
 <li>
 This is an evergreen role. Candidates will not receive immediate feedback, and applications will be reviewed as future classes are confirmed. The BCBSNE Talent Team will contact candidates whose experience aligns with upcoming needs.**
 
 
 </li>
 </ul>
 
 What You'll Do
 
 
 
 <ul>
 <li>
 Interfaces with customers via telephone, written correspondence, fax, web, and/or electronic mail.
 </li>
 <li>
 Research customer information utilizing appropriate systems, policies, regulations, procedures and other reference materials to effectively respond to and resolve customer issues.
 </li>
 <li>
 Elevates sensitive customer requests when necessary.
 </li>
 <li>
 Comply with State and Federal regulations and mandates, which are continually changing, thus creating a very dynamic environment, candidate is responsible to take initiative to stay current on policies and procedures required to support the customer and to ensure compliance.
 </li>
 <li>
 Accountable to remain current on knowledge of diverse products and proactively recommend items needed by customers to increase customer satisfaction and improve transaction profitability.
 
 
 </li>
 </ul>
 
 To Be Considered For This Position, You Must Have
 
 
 
 <ul>
 <li>
 High School Diploma or Equivalent and three years of experience in a complaint type customer service office setting (health insurance or related field preferred). An equivalent combination of education and experience may be substituted for this requirement.
 </li>
 <li>
 Availability for training 14 to 16 weeks in length.
 
 
 </li>
 </ul>
 
 The Strongest Candidates For This Position Will Also Possess
 
 
 
 <ul>
 <li>
 Basic medical/dental terminology and contract interpretation is a plus.
 
 
 </li>
 </ul>
 Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.
 
 
 
 We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.
 
</div>

Customer Service Rep - Work at Home in NE

Explore 5+ Medical review nurse analyst in Nebraska this May. Find roles across top companies and apply now to boost your career.

5 medical review nurse analyst jobs In Nebraska

Medical Review Nurse Analyst

Registered Nurse

Behavioral Health Medical Assistant

Clinical Pharmacist

Customer Service Rep - Work at Home in NE