[Hiring] Redetermination Examiner @Broadway Ventures

Role Description

As a Redetermination Examiner, you will be responsible for:

• Conducting redetermination reviews per Medicare rules and regulations.
• Responding to incoming appeals from Medicare appellants in a professional, timely, and accurate manner, including letter writing and proofreading with attention to detail following current guidelines.
• Researching and identifying claims processing deficiencies and initiating corrective responses.
• Evaluating all documentation and history needed to determine if it meets outlined policy criteria to ensure accurate and compliant processing in accordance with CMS guidelines.
• Submitting educational referrals as necessary to decrease redeterminations and allow claims to pay at the lowest level of appeal.
• Assisting in writing and updating processing guidelines.
• Identifying internal/external education and/or training needs, communicating findings, and assisting in training if necessary.
• Communicating information to appropriate internal and external parties in a timely manner.
• Problem solving and researching effectively.
• Processing overpayment appeals as needed.
• Maintaining up-to-date knowledge of working systems, processing instructions, and other relevant resources to ensure efficient and accurate appeal processing.
• Maintaining knowledge of CMS and Joint Operating Agreement (JOA) requirements.

Qualifications

• High School Diploma or GED.
• 6 months’ work-related experience.

Requirements

• 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.