Remote Medicare Appeals Nurse | First-Level Reviews

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

Benefits offered by this job

Remote and hybrid options

Performance bonus

401(k) with match

Paid time off

Health/Dental/Telehealth

Job summary

WPS is seeking an Appeals Nurse (RN) to evaluate medical records and claims for first-level Medicare appeals, ensuring medical necessity and compliance with guidelines. You will collaborate with Appeals Examiners to finalize redeterminations promptly.

The role supports remote work in approved US states, offers a salary of 66–68k USD annually, and requires ASN/BSN with an active RN license and 1+ year clinical experience.

Qualifications

• ASN or BSN required.
• Active RN license in good standing.
• 1+ year clinical healthcare experience.
• Strong written and verbal communication.
• Attention to detail and organization.
• Familiarity with medical review processes and MS Office tools.

Responsibilities

• Review first-level appeal cases for medical necessity and documentation.
• Perform medical record reviews to assess clinical necessity and guideline adherence.
• Prepare and submit written appeal letters with rationales and evidence.
• Ensure timely follow-up and resolutions per policies and regulations.
• Stay updated on healthcare laws and CMS/contractual requirements.
• Coordinate with Redetermination Representatives to meet CMS timelines.

Skills

Communication skills

RN license

Clinical experience

Attention to detail

Multitasking

MS Office proficiency

Education

ASN or BSN

Tools

MS Outlook

Teams

OneNote

Word

Excel

Job description

WPS is seeking an Appeals Nurse (RN) to evaluate medical records and claims for first-level Medicare appeals, ensuring medical necessity and compliance with guidelines. You will collaborate with Appeals Examiners to finalize redeterminations promptly.

The role supports remote work in approved US states, offers a salary of 66–68k USD annually, and requires ASN/BSN with an active RN license and 1+ year clinical experience.