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

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 and proofreading with attention to detail while 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.
• Maintains 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

Proficiencies:

• General PC knowledge
• Strong prioritization, analytical and communication skills
• Ability to adapt to changes

What to Expect Next:

After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.

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

Broadway Ventures offers a comprehensive benefits package:

• 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