Registered Nurse - Health Informatics Specialist

Company Info

WI Department of Health Services

United States

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Company Profile

Registered Nurse - Health Informatics Specialist


Job ID:



Madison, WI, United States 


Health Care Services


starting salary is $31-$36.97 per hour

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Employment Type:

Full time



Job Description:

~~ This position uses expert clinical judgment, medical coding, and data analysis expertise to detect fraud and abuse in DHS public assistance programs. This position assists in identifying issues, develops potential audits, and interacts with external entities to advise OIG management on audit practices that will enhance the overall efficiency, effectiveness and economy of the Medicaid program. The position provides the OIG management and staff with useful, timely and organized data to assist in OIG activities by detecting provider and member fraud and abuse of Department of Health Services (DHS) public assistance programs. This position completes special assignments at the request of the OIG management and responds to ad hoc inquiries from entities inside and external to DHS. The position provides training and technical assistance to Section Chief, OIG staff, other auditors, the Department of Justice, other agencies and providers as needed.

Job Requirements:

~~In addition to having a current, unrestricted licensure as a registered nurse (RN) in the State of Wisconsin, minimally qualified candidates will have:

•Experience working as an RN performing direct care activities for a at least three years in two or more clinical specialties. Note: The clinical experience can be obtained within the same environment (e.g. working in the same hospital in ICU and rehab would qualify).

•Experience with the design, development, testing or as a superuser or trainer in any of the following types of healthcare systems: electronic healthcare records, utilization review, case management, prior authorization, billing and claims, quality review.

•Experience conducting data analysis on healthcare related data.

•Excellent communication skills.

In addition, well-qualified candidates will also have:

•Experience in program integrity activities such as reviewing medical records for compliance with policies, reviewing medical claims for correct coding, or reviewing data for unusual billing patterns.

•Experience with managed care entities.

•Experience working with vendors/contractors.

•Certification as a medical coder or experience working in a medical coding or billing role.

•Data analysis or informatics education or training.