Medicare Appeals RN - Remote Review Specialist

WPS—A health solutions company; Georgia; Remote; USD 66,000 - 68,000; Full time

Benefits offered by this job

Remote or hybrid options

Bonuses or merit-based increases

401(k) with company match

Paid time off

Job summary

WPS, a health solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess medical necessity, and prepare rationale-supported letters. You will collaborate with Appeals Examiners to ensure timely redeterminations and adherence to CMS guidelines. Strong clinical background and communication skills are essential.

The role offers remote work options across approved states, with a base salary in the 66k–68k USD range and growth opportunities within a supportive team.

Qualifications

• ASN or BSN in Nursing required.
• Active RN license in good standing.
• 1+ year of clinical healthcare experience.
• Strong written and verbal communication.
• Attention to detail and organizational skills.
• Basic knowledge of medical review processes (Appeals/UR).
• Proficient with MS Office applications.

Responsibilities

• Review first-level appeal cases with medical documentation.
• Conduct medical record reviews to assess clinical necessity.
• Prepare and submit written appeal letters with rationales.
• Ensure timely follow-up and proper resolutions per policy.
• Maintain awareness of healthcare laws and CMS regulations.
• Coordinate with Redetermination Representatives to meet CMS timelines.

Skills

RN license

Communication

Attention to detail

Organizational skills

Clinical review knowledge

Education

ASN or BSN in Nursing

Tools

MS Outlook

Teams

OneNote

Word

Excel

Job description

WPS, a health solutions company, seeks an Appeals Nurse to review first-level appeal cases, assess medical necessity, and prepare rationale-supported letters. You will collaborate with Appeals Examiners to ensure timely redeterminations and adherence to CMS guidelines. Strong clinical background and communication skills are essential.

The role offers remote work options across approved states, with a base salary in the 66k–68k USD range and growth opportunities within a supportive team.