Appeals Nurse

WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.

The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare regulations and policies. The Appeals RN works in collaboration with the Appeals Examiners and Reps to ensure redeterminations are medically reviewed as needed and completed timely. Salary Range $66,000 - $68,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. Work Location We are open to remote work in the following approved states: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin

How do I know this opportunity is right for me? If you: Have moved away from direct patient care and want to continue using your nursing knowledge in a new and different way. Excel at analyzing information and critical thinking to make sound medical decisions. A highly organized and adept at researching and finding answers independently using all available resources. Thrive in a production environment where quality and production metrics are critical to individual and team success. Have strength in technical writing. Desire day hours with no on-call work and holidays off. Are technically strong on computers including MS Outlook, Teams, OneNote, Word, and Excel. Are self-motivated and work with a great degree of independence. Are looking for a full-time, permanent position. What will I gain from this role: Collaborating with a team of clinicians and non-clinicians. Learning a variety of systems, including but not limited to, the Medicare Appeal System (MAS) which is a content management system for Part A appeals and our Hyland OnBase tool which is our content management system used for Part B appeals. Experience working in an environment that serves our nation’s military, veterans, Guard and Reserves, and Medicare beneficiaries. Working in a continuous performance feedback environment.