Remote Medicare Appeals Nurse

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

Benefits offered by this job

Remote and hybrid work options

Performance bonus and merit increases

401(k) with 100% match up to 3%, 50%/3

Competitive PTO

Health, dental, telehealth start DAY 1

Professional and Leadership programs

Careers site review for more benefits

Job summary

WPS—A health solutions company is seeking an Appeals Nurse (RN) to review medical records and appeal decisions for first-level CMS cases. You will collaborate with Appeals Examiners to ensure timely, evidence-based determinations and required documentation supports redeterminations.

The role requires an active RN license and 1+ year clinical experience, with remote work options available in many states. Competitive benefits accompany a 66–68k/year salary and growth opportunities.

Qualifications

• Associate's or Bachelor's degree in nursing.
• Active RN license in good standing for state of practice.
• 1+ year clinical healthcare experience.
• Excellent written and verbal communication abilities.
• Strong attention to detail and organization.
• Basic knowledge of medical/clinical review processes (Appeals/UR).
• Proficient with MS Outlook/Teams/OneNote/Word/Excel.

Responsibilities

• Review and assess first-level appeal cases for denial of services.
• Perform medical record reviews to determine clinical necessity.
• Prepare and submit written appeal letters with rationales.
• Ensure timely follow-up and proper resolution per policy.
• Maintain awareness of healthcare laws and CMS requirements.
• Direct Redetermination Representatives to meet CMS timelines.

Skills

Communication skills

Attention to detail

Organizational skills

RN license (active)

Medical record review knowledge

MS Office proficiency

Education

ASN or BSN in Nursing

Tools

MS Outlook

Teams

OneNote

Word

Excel

Job description

WPS—A health solutions company is seeking an Appeals Nurse (RN) to review medical records and appeal decisions for first-level CMS cases. You will collaborate with Appeals Examiners to ensure timely, evidence-based determinations and required documentation supports redeterminations.

The role requires an active RN license and 1+ year clinical experience, with remote work options available in many states. Competitive benefits accompany a 66–68k/year salary and growth opportunities.