Redetermination Examiner (Medicare, DME) (6 Month Temp)
About The Position
Broadway Ventures is seeking a temporary Redetermination Examiner for a 6-month role. This position is 100% remote and training will be provided. The Redetermination Examiner will conduct redetermination reviews per Medicare rules and regulations, respond to incoming appeals from Medicare appellants, research and identify claims processing deficiencies, and evaluate documentation to ensure accurate and compliant processing in accordance with CMS guidelines. The role also involves submitting educational referrals, assisting in updating processing guidelines, identifying training needs, communicating information to relevant parties, problem-solving, processing overpayment appeals, and maintaining up-to-date knowledge of systems and requirements.
Requirements
- High School Diploma or GED
- 6 months’ work-related experience
- General PC knowledge
- Strong prioritization, analytical and communication skills
- Ability to adapt to changes
Nice To Haves
- Medicare, DME experience
Responsibilities
- 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
Benefits
- 401(k) and company match
- PTO that grows the longer you stay
- Health, Vision, Dental
- Company provided Life Insurance and Voluntary Life Insurance
- Short Term Disability and Long Term Disability
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
