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

The role

The Redetermination Examiner conducts redetermination reviews per Medicare rules and regulations. This person responds to appeals, researches claims processing deficiencies, and evaluates documentation to ensure compliance with CMS guidelines.

What you will do

• Conducts redetermination reviews per Medicare rules and regulations.
• Responds to incoming appeals from Medicare appellants.
• Researches and identifies claims processing deficiencies and initiates corrective response.
• Evaluates documentation and history to ensure accurate and compliant processing in accordance with CMS guidelines.
• Submits educational referrals as necessary.
• Assists in writing and updating processing guidelines.
• Identifies internal/external education and/or training needs.
• Communicates information to appropriate internal and external parties.
• Processes overpayment appeals as needed.
• Maintains knowledge of CMS and Joint Operating Agreement (JOA) requirements.

Required qualifications

• High School Diploma or GED
• 6 months work-related experience
• General PC knowledge
• Strong prioritization, analytical and communication skills
• Ability to adapt to changes

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

Before you apply

• Candidates must live in and work from an eligible U.S. state.
• Broadway Ventures conducts background checks and drug testing prior to the start of employment.
• Some positions may also require fingerprinting.
• An artificial intelligence tool is used to review applications by comparing resumes to requirements.

About the company

Broadway Ventures is an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB) that provides program management, technology, and consulting solutions.