Company Nurse
Wisconsin Physicians Service Insurance Corporation
To support the appeals process, the full-time remote Wisconsin Licensed Appeals Nurse will examine medical records and claims for first-level appeal cases, ensuring compliance with Medicare guidelines and collaborating with Appeals Examiners to facilitate timely redeterminations.
Key responsibilities Review and assess first-level appeal cases for denied services, ensuring all medical documentation is complete
Conduct comprehensive medical record reviews to determine clinical necessity and prepare written appeal letters
Ensure timely follow-up on all appeals and maintain compliance with healthcare regulations and policies
Required qualifications Associate's (ASN) or Bachelor's Degree in Nursing (BSN)
Active RN license in good standing applicable to state of practice
One (1) or more years of clinical experience in a healthcare setting
Basic knowledge of medical/clinical review processes, including Appeals and Utilization Review
Solid computer skills with experience in online systems such as MS Outlook, Teams, and Word
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Vacancy posted 3 days ago
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