Medicare Appeals & Redetermination Specialist (Remote)

Broadway Ventures LLC; United States; A distancia; USD 26.000 - 34.000; A tiempo parcial

Ventajas ofrecidas por este puesto de trabajo

401(k) match

PTO that grows with tenure

Health, Vision, Dental

Descripción de la vacante

Broadway Ventures is seeking a Redetermination Examiner to conduct Medicare redetermination reviews and respond to appeals on a fully remote, six-month basis.

The role requires evaluating documentation, ensuring CMS guideline compliance, and updating processing guidelines as needed. Training will be provided, and the position emphasizes accuracy, timely communication, and problem-solving.

Formación

• High School Diploma or GED.
• 6 months’ work-related experience.

Responsabilidades

• Conducts redetermination reviews per Medicare rules and regulations.
• Responds to incoming appeals from Medicare appellants in a professional, timely, and accurate manner.
• Researches and identifies claims processing deficiencies and initiates corrective response.
• Evaluates all documentation and history needed to determine if it meets outlined policy criteria to ensure accurate and compliant processing in accordance with CMS guidelines.
• Submits educational referrals as necessary to decrease redeterminations and allow claims to pay at the lowest level of appeal.
• Assists in writing and updating processing guidelines.
• Identifies internal/external education and/or training needs, communicates findings, and assists in training if necessary.
• Communicates information to appropriate internal and external parties in a timely manner.
• Problem solves and researches effectively.
• Processes overpayment appeals as needed.
• Maintain up-to-date knowledge of working systems, processing instructions, and other relevant resources to ensure efficient and accurate appeal processing.
• Maintains knowledge of CMS and Joint Operating Agreement (JOA) requirements

Conocimientos

General PC knowledge

Prioritization

Analytical skills

Communication skills

Adaptability

Educación

High School Diploma or GED

Descripción del empleo

Broadway Ventures is seeking a Redetermination Examiner to conduct Medicare redetermination reviews and respond to appeals on a fully remote, six-month basis.

The role requires evaluating documentation, ensuring CMS guideline compliance, and updating processing guidelines as needed. Training will be provided, and the position emphasizes accuracy, timely communication, and problem-solving.