Remote Medicare Appeals Nurse

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

Benefits offered by this job

Remote options

Performance bonus

401(k) match

PTO

Health insurance

Telehealth

Professional development

Job summary

The Appeals Nurse role at WPS—A health solutions company focuses on reviewing medical records and claims to determine medical necessity for first-level appeal cases under Medicare guidelines. You will collaborate with Appeals Examiners to ensure timely redeterminations.

Requirements include an active RN license, ASN/BSN, 1+ year clinical experience, and strong communication with MS Office tools; remote work options are available across approved states.

Qualifications

• ASN or BSN in Nursing with active RN license.
• 1+ year of clinical experience in healthcare.
• Excellent written and verbal communication; detail-oriented and organized.
• Familiarity with medical/clinical review processes (Appeals/Utilization Review).
• Proficient with MS Office tools (Outlook, Teams, Word, Excel).

Responsibilities

• Review and assess first-level appeal cases for denied services.
• Conduct medical record reviews to determine clinical necessity.
• Prepare and submit written appeal letters with rationales and evidence.
• Ensure timely follow-up and proper resolution per policies and CMS requirements.
• Stay current on healthcare laws and CMS regulations relevant to appeals.
• Coordinate with Redetermination Representatives to meet CMS timelines.

Skills

Communication

Attention to detail

Organization

Medical review knowledge

Education

ASN or BSN in Nursing

Active RN license in good standing

Tools

MS Outlook

Teams

OneNote

Word

Excel

Job description

The Appeals Nurse role at WPS—A health solutions company focuses on reviewing medical records and claims to determine medical necessity for first-level appeal cases under Medicare guidelines. You will collaborate with Appeals Examiners to ensure timely redeterminations.

Requirements include an active RN license, ASN/BSN, 1+ year clinical experience, and strong communication with MS Office tools; remote work options are available across approved states.