Remote Medicare Redetermination Claims Specialist

Broadway Ventures LLC; United States; À distance; USD 29 000 - 33 000; Plein temps

Avantages offerts par ce poste

401(k) match

PTO

Health insurance

Vision plan

Dental plan

Life Insurance

Disability

Résumé du poste

Broadway Ventures is seeking a detail-oriented Medicare Appeals Reviewer to support first-level Medicare redetermination requests. You will review medical documentation, determine coding and medical necessity, and draft decision explanations using CMS guidelines.

The role offers a flexible remote schedule across approved states and a competitive hourly pay. Key responsibilities include handling MRN requests, coordinating with appeal nurses when needed, and ensuring accurate fee determinations

Qualifications

• Knowledge of Medicare regulations and claims processing.
• Ability to apply policy guidelines to determine proper resolutions.
• Experience with writing explanations of decision and using templates.

Responsabilités

• Receive and respond to MRN requests in the first level of Medicare appeal.
• Review medical documentation and claims history for coding elements and medical necessity.
• Refer cases to appeal nurses when clinical judgment is needed or required by audit.
• Determine appropriate resolution and adjudicate redetermination decisions.
• Develop explanations of decision for MRN letters using templates and CMS guidance.
• Communicate with Medicare customers to clarify information and explain adjudication.
• Assist providers with CMS guidelines to ensure correct submissions.

Connaissances

Medicare knowledge

Claims processing

Customer service

Research

Formation

High School diploma or equivalent

Description du poste

Broadway Ventures is seeking a detail-oriented Medicare Appeals Reviewer to support first-level Medicare redetermination requests. You will review medical documentation, determine coding and medical necessity, and draft decision explanations using CMS guidelines.

The role offers a flexible remote schedule across approved states and a competitive hourly pay. Key responsibilities include handling MRN requests, coordinating with appeal nurses when needed, and ensuring accurate fee determinations