Remote Medicare Redetermination Specialist

Broadway Ventures LLC; 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

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.