Redetermination Examiner (Medicare, DME) (6 Month Temp)

Broadway Ventures; United States; Remote; USD 25,000 - 36,000; Full time

Benefits offered by this job

Training provided

Remote work

Job summary

Broadway Ventures LLC is seeking a Redetermination Examiner to support Medicare appeals in a fully remote, temporary 6-month role. The position offers training and requires a High School Diploma or GED with at least 6 months of related experience.

Strong analytical and communication skills are essential as you review and respond to appeals per CMS guidelines. You will contribute by researching processing deficiencies, updating guidelines, and maintaining knowledge of CMS requirements.

Qualifications

• High School Diploma or GED required.
• 6 months’ work-related experience preferred.
• General PC knowledge expected.
• Strong prioritization, analytical and communication skills.
• Ability to adapt to changes.

Responsibilities

• Conducts redetermination reviews per Medicare rules and regulations.
• Responds to incoming appeals from Medicare appellants with professional, timely, and accurate communication.
• Researches and identifies claims processing deficiencies and initiates corrective response.
• Evaluates all documentation to determine policy criteria and ensure compliant processing.
• Submits educational referrals to reduce redeterminations and help claims pay at the lowest level.

Skills

Analytical skills

Communication skills

PC literacy

Prioritization

Education

High School Diploma or GED

Job description

United States

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

Redetermination Examiner

• Rate: $22/Hour
• Temporary 6 month role
• Training will be provided
• 100% Remote

Key Duties/Responsibilities/Accountabilities:

• Conducts redetermination reviews per Medicare rules and regulations.
• Responds to incoming appeals from Medicare appellants in a professional, timely, and accurate manner. Including letter writing, proofreading with attention to detail following current guidelines.
• 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

Minimum Qualifications:

• High School Diploma or GED
• 6 months’ work-related experience
• General PC knowledge
• Strong prioritization, analytical and communication skills
• Ability to adapt to changes

Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.

Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).

The pay range shown is a good-faith estimate of the compensation Broadway Ventures reasonably expects to pay for this position at the time of posting. It is not a guarantee of any particular wage, salary, or total compensation. Actual pay offered depends on job-related factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget. For positions covered by the Service Contract Act, pay is also governed by the applicable Department of Labor wage determination, which the government may revise.
Location Eligibility: Broadway Ventures cannot consider applicants who live in, or would work from, any of the following locations: California, Colorado, Connecticut, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, Washington State, and Wyoming. Candidates must live in and work from an eligible U.S. state when they are hired and for as long as they are employed. Applications from residents of the locations listed above will not be considered.

Notice: Use of Artificial Intelligence in Our Hiring Process

• Who built it: Broadway Ventures developed the tool in-house.
• What it does: It compares your resume to the requirements in this job posting and gives a score from 0 to 100 showing how closely your qualifications match.
• What information it uses: The text of your resume, your name, your current or most recent job title, your location, and this job posting.
• What it cannot see: Your answers to voluntary demographic or equal employment opportunity questions, interview feedback, or offer information.
• How it is used: The score is one factor in our initial review of applications. The tool does not reject anyone. A member of our recruiting team reviews every application before any decision is made.
• Your options: If you would like your application reviewed without the AI tool, or you need a reasonable accommodation at any point in the hiring process, contact us at [e-mail]. Making a request will not affect whether you are considered for this position.

Some positions are posted in support of a contract proposal that has not yet been awarded. Where that is the case, the position and its final compensation are contingent upon award of the contract to Broadway Ventures and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination.

Broadway Ventures offers a comprehensive benefits package. A general description of benefits is below.

• 401(k) and company match
• PTO that grows the longer you stay
• Company provided Life Insurance and Voluntary Life Insurance
• Short Term Disability and Long Term Disability

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file.

As set forth in Broadway Ventures’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service‑connected disability.

A "recently separated veteran" means any veteran during the three‑year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

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