Remote Redetermination Examiner – Medicare Appeals

Broadway Ventures; United States; On-site; USD 25,000 - 36,000; Part time

Benefits offered by this job

401(k) and company match

PTO that grows with tenure

Life Insurance and Voluntary Life

Short/Long Term Disability

Job summary

Broadway Ventures, a US-based firm delivering government and private sector solutions, is seeking a Redetermination Examiner for Medicare appeals, remotely. This 6-month, 100% remote temporary role requires reviewing redeterminations, responding to appellants, identifying processing gaps, and updating guidelines under CMS/JOA rules.

Training will be provided. Ideal candidates hold a High School Diploma or GED, have about 6 months of related experience, and demonstrate strong analytical and

Qualifications

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

Responsibilities

• Conducts redetermination reviews per Medicare rules and regulations.
• Responds to incoming appeals from Medicare appellants professionally and timely.
• Researches and identifies claims processing deficiencies and initiates corrective response.
• Evaluates documentation to determine policy criteria for CMS compliance.
• Submits educational referrals to decrease redeterminations and improve outcomes.
• Assists in writing and updating processing guidelines.
• Identifies training needs and assists in delivering training when needed.
• Maintains knowledge of CMS and JOA requirements.

Skills

Analytical skills

Communication skills

Adaptability

General PC knowledge

Education

High School Diploma or GED

Job description

Broadway Ventures, a US-based firm delivering government and private sector solutions, is seeking a Redetermination Examiner for Medicare appeals, remotely. This 6-month, 100% remote temporary role requires reviewing redeterminations, responding to appellants, identifying processing gaps, and updating guidelines under CMS/JOA rules.

Training will be provided. Ideal candidates hold a High School Diploma or GED, have about 6 months of related experience, and demonstrate strong analytical and