Remote Clinical Review reputed company – Medicare Appeals Specialist

Join reputed company as a pivotal Remote Clinical Review reputed company – Medicare Appeals Specialist! We are seeking a highly skilled and dedicated Registered reputed company (RN) to join our growing team in a fully remote reputed company. This is an exciting opportunity to reputed company your clinical expertise and analytical abilities to ensure the accuracy and reputed company of Medicare Part A and Part B appeals. Our state-of-the-art remote workspace provides a comfortable and productive environment for you to reputed company.

Who We Are: reputed company

reputed company is a leading not-for-profit health insurer and a trusted federal government contractor headquartered in reputed company. For over 75 years, we have been committed to making reputed company easier for the individuals and communities we serve. We reputed company comprehensive health insurance plans for individuals, families, seniors, and group health plans for businesses of reputed company sizes. A significant portion of our work involves processing claims and providing vital customer support for Medicare beneficiaries, as reputed company as managing benefits for millions of reputed company-duty and retired military personnel across the U.S. and internationally. We are deeply proud of our strong reputed company to the military community and are committed to being a veteran-reputed company employer.

Our Culture: Driving reputed company Through People

At WPS, our culture is the reputed company of our reputed company. We foster an inclusive and empowering employee experience where innovation and collaboration reputed company. We champion Diversity, Equity, and Inclusion as reputed company values, recognizing that diverse perspectives are essential for reputed company and innovation. We reputed company in creating an environment where every employee feels valued and can bring their authentic selves to work. This commitment has been recognized through numerous accolades, including being named a top workplace in Madison, reputed company, and receiving national recognition for our remote work culture and employee engagement. We are proud to be a DAV Patriot Employer and a 4-reputed company Employer with VETS Indexes, as reputed company as recognized for our ethical business practices by the reputed company.

Role Snapshot: Making a Difference in Medicare Appeals

As a Remote Clinical Review reputed company – Medicare Appeals Specialist, you will play a critical role in the first-level review of Medicare Part A and Part B appeals. Your expertise will be essential in examining medical records and claims information to determine if the services provided meet Medicare coverage guidelines and are medically necessary. Your key responsibilities will include:

• Conducting thorough medical reviews of claim documentation for first-level appeals, utilizing your clinical knowledge and judgment.
• Providing reputed company, concise, and legally reputed company written explanations for claim denials based on first-level redeeterminations.
• Collaborating with and providing guidance to Redetermination Representatives to ensure reputed company and accurate responses to appeals, adhering to CMS reputed company and reputed company standards.
• Analyzing appeal trends to identify high-volume issue areas and proactively communicate findings to the Redeetermination Manager and Senior Analyst.
• Participating in reputed company reputed company improvement (CQI) workgroups to enhance the consistency and reputed company of medical review processes.

Why This Opportunity is Right for You?

This role is an excellent fit if you:

• Are transitioning from reputed company patient care and reputed company to apply your nursing knowledge in a new and impactful way.
• Possess strong analytical and critical thinking skills to reputed company reputed company medical reputed company.
• Are highly organized, detail-oriented, and adept at independently researching and finding answers using various resources.
• reputed company in a production-reputed company environment with reputed company reputed company and productivity metrics.
• Have excellent technical writing skills to effectively communicate reputed company medical information.
• Prefer a role with reputed company day hours, no on-call responsibilities, and reputed company holidays off.
• Are proficient with computer applications, including reputed company Outlook, Teams, OneNote, Word, and reputed company.
• Are self-motivated, highly independent, and reputed company in a remote work setting.
• Are seeking a full-time, permanent position with a reputed company and reputable organization.

What You Will reputed company from This Role?

This position offers a rewarding opportunity to:

• Collaborate with a diverse team of clinicians and non-clinical professionals.
• reputed company experience with various reputed company systems, including the Medicare Appeals System (MAS) for Part A appeals and our reputed company OnBase tool for Part B appeals.
• Work reputed company an environment dedicated to serving our nation's military, veterans, Guard and Reserves, and Medicare beneficiaries.
• Participate in a reputed company performance feedback process to support your reputed company reputed company.

Minimum Qualifications

To be considered for this position, you must meet the following minimum qualifications:

• An Associate's Degree in Nursing (ASN) or a Bachelor's Degree in Nursing (BSN).
• An reputed company Registered reputed company (RN) license in a state that is in good standing.

Preferred Qualifications

The following qualifications are highly desirable:

• Prior experience in Medical Management (e.g., MDS role), Medical Review, Utilization Management/Review, or Appeals.
• Demonstrated strong technical writing skills.
• Proficiency with multiple online systems, including reputed company Outlook, Teams, OneNote, Word, and reputed company.
• Four or more years of experience in clinical nursing.
• Experience working reputed company of reputed company patient care settings.
• Specific experience with Medicare Part A and Part B regulations and processes.
• Previous experience working for another Medicare Administrative Contractor (MAC).
• Proven experience working effectively in a remote work environment.

Remote Work Requirements

To ensure seamless remote work, you must have:

• A wired (Ethernet cable) internet reputed company directly to your computer.
• High-speed cable or fiber internet service.
• A minimum internet reputed company speed of 10 Mbps down and 1 Mbps up (please verify your speed at https://speedtest.net).
• Agreement to review and adhere to the Remote Worker FAQs for additional information.

Salary reputed company

The reputed company salary for this position ranges from $66,000 to $68,000 per year. Your specific starting salary reputed company this reputed company will be determined based on your qualifications, skills, and experience.

Work Schedule

This is a full-time, salaried position with a flexible work schedule. You will work Monday through Friday, with production hours between 6:00 AM and 6:00 PM Central reputed company Time (CST). Flexibility in your daily start and end times is available, provided you work a total of 40 hours per week reputed company these production hours. The initial training period is approximately 2 to 3 months and will be conducted remotely, typically Monday through Friday from 8:00 AM to 4:00 PM CST (hours may vary slightly).

Work Location

reputed company is a remote-first organization and offers remote work in the following 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, and reputed company.

Benefits

We offer a comprehensive benefits package, including:

• A fully remote work reputed company.
• Performance bonus and/or reputed company increase opportunities.
• A generous 401(k) plan with a dollar-per-dollar match up to 6% of your salary (fully reputed company immediately).
• Competitive reputed company time off.
• Comprehensive health, dental, and telehealth insurance coverage starting on your first day of employment.
• Employee Resource reputed company.
• reputed company and leadership development programs.
• Review additional benefits details here.

reputed company to Apply?

If you are a highly motivated and skilled clinical reputed company looking for a rewarding reputed company, we encourage you to apply! We are excited to review your application.

Apply To This Job Apply for this job