Medicare Appeals Manager (HH & H)

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 reports related to performance, staffing, budget, training, and resource needs.
• Are data driven and look to metrics in decision-making through regular, comprehensive reporting.
• Like to manage and coordinate operational and reporting activities with subcontractors and other CMS contractors.
• Can ensure seamless collaboration and compliance with agreements and joint operating standards.

Minimum Qualifications

• Bachelor's Degree in related field or equivalent post high school and/or related work experience.
• 5 or more years of experience in appeals, claims processing, customer service, or outreach.
• 2 or more years of supervisory/team lead experience in Medicare Part A, Part B, or Home Health and Hospice operations.
• Extensive knowledge of Medicare Part A, Part B and/or Home Health and Hospice program guidelines and appeals processes.
• Excellent verbal and written communication skills with the ability to effectively explain complex information.
• Strong analytical, problem-solving, and organizational skills with the ability to manage multiple processes simultaneously and meet strict deadlines.
• Demonstrated leadership and team-building capabilities.
• Ability to identify, prioritize and drive work efforts that result in more efficient operations through innovation or process improvement.
• Ability to work in a complex, rapidly evolving environment with multiple internal and external stakeholders.

Preferred Qualifications

• CMS knowledge of the Home Health and Hospice program.
• Experience processing Home Health and Hospice appeals.
• MAC contractor experience with FISS, MCS and MAS systems.

Remote Work Requirements

• Wired (ethernet cable) internet connection from your router to your computer
• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net)
• Please review Remote Worker FAQs for additional information

Benefits

• Remote and hybrid work options available
• Performance bonus and/or merit increase opportunities
• 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Professional and Leadership Development Programs
• Review additional benefits: (https://www.wpshealthsolutions.com/careers/fulltime_benefits.shtml)

Who We Are

WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS' culture is where the great work and innovations of our people are seen, fueled and rewarded. We accomplish this by creating an open and empowering employee experience. We recognize the benefits of employee engagement as an investment in our workforce-both current and future-to effectively seek, leverage, and include differing and unique perspectives that fuel agility 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.

We are proud of the recognition we have received from local and national organization regarding our culture and workplace: WPS Newsroom - Awards and Recognition.

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This position supports services under Centers for Medicare & Medicaid Services (CMS) contract(s). As such, the role is subject to all applicable federal regulations, CMS contract requirements, and WPS internal policies, including but not limited to standards for data security, privacy, confidentiality, and program integrity. CMS contractors and their personnel are subject to screening and background investigation prior to being granted access to information systems and/or sensitive data to safeguard government resources that provide critical services.