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Job Title:

M&R Appeals Coder City:

Atlanta State/Province:

California Posting Start Date:

8/28/26 Wipro Limited (

NYSE:

WIT, BSE

507685,

NSE:

WIPRO) 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. For additional information, visit us at www.wipro.com.

Job Description:

Job Description 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 conditions of coverage exist. If conditions are not met, the specialist will provide an uphold justification.

Volumes:

300 cases per week

FTEs:

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. Attention to detail and accuracy. Strong written and verbal communication skills. Ability to work independently and as part of a team. Familiarity with CMS guidelines and Medicare policies.

Preferred Qualifications:

Previous experience in a similar role. Knowledge of healthcare regulations and compliance. ͏ Deliver No Performance Parameter Measure 1 Process No. of cases resolved per day, compliance to process and quality standards, meeting process level SLAs, Pulse score, Customer feedback 2 Self- Management Productivity, efficiency, absenteeism, Training Hours, No of technical training completed

Mandatory Skills:

Claims_Processing . The expected compensation for this role ranges from $24/hr to $25/hr . Final compensation will depend on various factors, including your geographical location, minimum wage obligations, skills, and relevant experience. Based on the position, the role is also eligible for Wipro's standard benefits including a full range of medical and dental benefits options, disability insurance, paid time off (inclusive of sick leave), other paid and unpaid leave options. Applicants are advised that employment in some roles may be conditioned on successful completion of a post-offer drug screening, subject to applicable state law. Wipro provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. Applications from veterans and people with disabilities are explicitly welcome. Reinvent your world. We are building a modern Wipro. We are an end-to-end digital transformation partner with the boldest ambitions. To realize them, we need people inspired by reinvention. Of yourself, your career, and your skills. We want to see the constant evolution of our business and our industry. It has always been in our DNA - as the world around us changes, so do we. Join a business powered by purpose and a place that empowers you to design your own reinvention. Apply now Apply Now Start applying with LinkedIn Start Please wait... Information at a Glance Get Job Alerts Receive notifications when we have open roles and get other relevant career news Register > Join Us Explore open roles that match your interests and skills Search Jobs >