Appeals Nurse Remote
WPS Health•Madison, WI
417d
This job is no longer available
There are still lots of open positions. Let's find the one that's right for you.
About The Position
The Appeals Nurse at WPS Health Solutions plays a crucial role in examining medical records and claims information for first-level appeal cases. This position is responsible for determining the medical necessity of services provided and ensuring compliance with Medicare coverage guidelines. The Appeals Nurse utilizes clinical knowledge to conduct thorough medical reviews, provides clear explanations for claim denials, and collaborates with Redetermination Representatives to meet quality standards. This role also involves analyzing appeals for high-volume issues and participating in Continuous Quality Improvement initiatives.
