Medicare Appeals Manager

WPS Health Solutions • Madison, WI • 2h ago

JOB REQUIREMENTS: Description Role Snapshot Our Medicare Appeals Manager
(HH & H - Home Health and Hospice) oversees the first-level appeals
processes this includes investigations, resolutions, documentation, and
follow-up in alignment with regulatory standards. They ensure timely,
accurate reporting of Medicare Administrative Contractor (MAC)
deliverables and supports process improvements through trend analysis.
This Medicare Appeals Manager monitors departmental performance, ensures
CMS (Center for Medicare and Medicaid Services) compliance, and
collaborates with internal teams to optimize outcomes. Serves as a key
liaison with CMS and internal stakeholders to support operational
efficiency and regulatory compliance within the Home Health and Hospice
services. Salary Range 90,000 \~120,000 The base pay offered for this
position may vary within the posted range based on your job-related
knowledge, skills, experience and may fall outside of this range. 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: Possess experience working with Medicare specifically in the Home
Health and Hospice space. Have planned, organized, managed, and
evaluated departmental operations, including direct management of staff
across multiple sites and domains. Would like to develop, manage, and
monitor the department budget to ensure alignment with approved funding
levels while supporting responsible financial management by controlling
costs and contributing to the organization\'s overall fiscal
accountability. Enjoy overseeing day-to-day departmental activities,
resource allocation, and staff performance to meet organizational goals.
Can ensure accurate and timely handling of Part A and Part B
redetermination decisions, payment adjustments, QIC case file
forwarding, ALJ effectuations, and record retention. Have ensured
operational accuracy and compliance with Medicare standards across
appeals processing functions. Are detail oriented and can ensure
accurate and timely reporting of all Medicare Administrative Contractor
(MAC) Statement of Work (SOW) deliverables. Can maintain accountability
for key regulatory deliverables and align reporting with CMS
expectations. Want to be responsible for responding to operational
concerns raised by Medicare providers, attorneys, beneficiaries, CMS,
internal WPS areas, and contractors. Have supported external and
internal customer satisfaction by addressing escalated issues and
inquiries. Enjoy preparing and providing detailed management... For
full info follow application link. Wisconsin Physicians Service
Insurance Corporation is an Equal Opportunity Employer/Protected
Veterans/Individuals with Disabilities employer. *** APPLICATION
INSTRUCTIONS: Apply Online: ipc.us/t/BB850CAC07AF4329 Qualified females,
minorities, and special disabled veterans and other veterans are
encouraged to apply.

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