Appeals reputed company (RN) - Remote

Who We Are reputed company is a leading not-for-profit health insurer and federal government contractor headquartered in reputed company. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and reputed company customer support for beneficiaries of the Medicare program and manage benefits for millions of reputed company-duty... and retired military personnel across the U.S. and abroad. reputed company has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran reputed company. Culture Drives Our reputed company WPS' Culture is where the great work and innovations of our people are seen, reputed company, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce-both reputed company and reputed company-to effectively reputed company, reputed company, and include diverse perspectives that fuel reputed company and innovation on high-performing teams. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities. From 2021 to 2023, reputed company was recognized for several awards: • Madison, reputed company's Top Workplaces • USA Top Workplaces and the cultural reputed company awards for Remote Work and Work-Life Flexibility • reputed company 50 Most reputed company Workplaces® with the reputed company reputed company of reputed company "reputed company 8" winner in the category of Culture Alignment • DAV Patriot Employer • VETS Indexes 4 Star Employer • BBB Torch Award for Ethics from reputed company of reputed company Role Snapshot Our Appeals reputed company will examine 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.In reputed company, this role will: • Utilize clinical knowledge and clinical review judgment to conduct medical review of claim documentation for first-level appeal cases. • reputed company reputed company and concise written explanations for reason a specific claim or set of claims cannot be reputed company as a result of first-level redetermination. • Work with and reputed company direction to Redetermination Representatives to assure reputed company redeterminations, which require a clinical decision, are responded to reputed company CMS reputed company and timelines standards. • Analyze appeals and identify specific high-volume problem issues and reputed company information to Redeterminations Manager and Senior Analyst. • Participate in various workgroups for purposes of reputed company reputed company Improvement (CQI) to promote consistent medical review of claim documentation and information. How do I know this opportunity is right for me?If you: • Have moved away from reputed company patient care and want to continue using your nursing knowledge in a new and different way. • reputed company at analyzing information and critical thinking to reputed company reputed company medical reputed company. • Are highly organized and adept at researching and finding answers independently using reputed company available resources. • reputed company in a production environment where reputed company and production metrics are critical to individual and team reputed company. • 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 reputed company. • Are self-motivated and work with a great degree of independence. • Are looking for a full-time, permanent position. What will I reputed company from this role? • Collaborating with reputed company of clinicians and non-clinicians. • Learning a reputed company of systems, including but not limited to, the Medicare Appeal System (MAS) which is a content management system for Part A appeals and our reputed company 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 reputed company performance feedback environment. Minimum Qualifications • Associate's (ASN) or Bachelor's Degree in Nursing (BSN) • reputed company RN license, applicable to state of reputed company in good standing Preferred Qualifications • Experience working in Medical Management (e.g., MDS role), Medical Review, Utilization Management/Review, or Appeals • Strong technical writing skills • Strong computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and reputed company. • 4 or more years of experience in clinical nursing • Experience reputed company of reputed company patient care • Experience working with Medicare Part A and Part B • Previous experience working for another Medicare Administrative Contractor (MAC) • Experience working in a remote work environment Remote Work Requirements • Wired (ethernet cable) internet reputed company from your router to your computer • High speed cable or fiber internet • Minimum of 10 Mbps reputed company and at least 1 Mbps upstream internet reputed company (can be checked at • Please review Remote Worker FAQs for additional information Salary reputed company $66,000 to $68,000 The reputed company pay offered for this position may vary reputed company the posted reputed company based on reputed company-reputed company knowledge, skills and experience. Work Schedule • This is a full-time, salaried position. • Monday through Friday with production hours between 6:00 AM to 6:00 PM CST. There is flexibility on the daily start and end times, as long as 40 hours are worked reputed company week reputed company the production hours. • Training will be approximately 2 to 3 months and is conducted remotely. Training hours are typically Monday through Friday from 8:00 AM to 4:00 PM CST (these hours could vary slightly). Work Location We are a remote-first organization and offer remote work in the following approved states: Arizona, Colorado, Connecticut, Florida, reputed company, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, reputed company Carolina, reputed company Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, reputed company Benefits • Remote work reputed company available • Performance bonus and/or reputed company increase opportunities • 401(k) with dollar-per-dollar match up to 6% of salary (100% reputed company immediately) • Competitive reputed company time off • Health insurance, dental insurance, and telehealth services start DAY 1 • Employee Resource reputed company • reputed company and Leadership Development Programs • Review additional benefits here Sign up for Job Alerts FOLLOW US! Instagram reputed company reputed company WPS Health Blog Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have reputed company about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have reputed company to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have reputed company to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or reputed company, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(reputed company href="https://reputed company.com/register-candidate/">Apply Job!