Wipro

M&R Appeals Coder Wipro Limited is a leading technology services and consulting company focused on building innovative solutions that address clients' most complex digital transformation needs. Leveraging our holistic portfolio of capabilities in consulting, design, engineering, and operations, we help clients realize their boldest ambitions and build future-ready, sustainable businesses. With over 230,000 employees and business partners across 65 countries, we deliver on the promise of helping our customers, colleagues, and communities thrive in an ever-changing world. Function Asks: We are seeking dedicated and detail-oriented specialists who possess a coding certificate and have a strong understanding of records review. They will be responsible for handling appeals for Medicare members, specifically working on NCD/LCD denials, Duplicate denials, and MUE denials. The role involves reviewing medical records, comparing findings to CMS guidelines, and determining if...

Volumes: 1 domestic resources Key Responsibilities: Review and analyze medical records for Medicare appeals. Work on NCD/LCD denials, Duplicate denials, and MUE denials. Compare medical findings to CMS guidelines. Determine if conditions of coverage are met. Provide uphold justifications when conditions of coverage are not met. Maintain accurate and detailed documentation of all reviews and decisions. Communicate effectively with team members and other stakeholders. Stay updated with CMS guidelines and changes in Medicare policies. Initially focus on FACETS cases, with plans to expand to COSMOS cases. Handle additional coding-related scenarios as the team expands. Qualifications: Coding certificate (CPC, CCS, or equivalent). Strong understanding of medical records review. Experience with Medicare appeals and denials (NCD/LCD, Duplicate, MUE). Experience with FACETS (primary). Experience with COSMOS (secondary). Excellent analytical and problem‑solving skills....

Wipro in Atlanta, GA is seeking a Medicare Appeals Review Specialist to analyze medical records and determine coverage decisions. You will review NCD/LCD denials, Duplicates, and MUE cases, comparing findings to CMS guidelines and documenting each step. The role requires a CPC/CCS certificate, strong analytical skills, and the ability to work independently as well as part of a team. Experience with FACETS is preferred, with COSMOS exposure as a plus. #J-18808-Ljbffr