Redetermination Examiner, Medicare, DME

This is a fully remote position, open to applicants in United States.

📋 Description

• Conduct redetermination reviews in accordance with Medicare regulations and guidelines.

• Professionally and accurately respond to incoming appeals from Medicare appellants in a timely manner.

• Draft and proofread letters following current standards.

• Research and pinpoint claims processing deficiencies, initiating corrective actions as needed.

• Assess documentation and history against policy criteria to ensure accurate, CMS-compliant processing.

• Submit educational referrals as required to reduce redeterminations and facilitate claims payments at the lowest appeal level.

• Assist in the development and updating of processing guidelines.

• Identify educational and training needs, both internal and external, communicate findings, and aid in training as necessary.

• Relay information to the appropriate internal and external stakeholders.

• Effectively problem-solve and conduct research.

• Manage overpayment appeals as required.

• Keep abreast of working systems, processing instructions, and relevant resources.

• Stay informed about CMS and Joint Operating Agreement requirements.

⛳️ Requirements

• High School Diploma or GED.

• At least 6 months of relevant work experience.

• Basic knowledge of personal computers.

• Strong skills in prioritization, analysis, and communication.

• Ability to adapt to changes effectively.

• Candidates must reside in and work from an eligible U.S. state during employment.

• Broadway Ventures performs background checks and drug testing prior to employment commencement.

• Some positions may also necessitate fingerprinting.

🏝️ Benefits

• 401(k) plan with company matching.

• Paid Time Off (PTO) that increases with tenure.

• Health, Vision, and Dental insurance.

• Company-paid Life Insurance and optional Voluntary Life Insurance.

• Short Term and Long Term Disability coverage.

• Training will be provided.