RemoteMust live and work in an eligible U.S. state; applicants from the listed excluded states and locations are not considered.
Medical, Clinical & Veterinary
About the job
Requirements
High school diploma or GED.
Six months of work-related experience.
General personal computer knowledge.
Ability to prioritize work and perform analytical tasks.
Responsibilities
Conduct redetermination reviews in accordance with Medicare rules and regulations.
Respond to incoming appeals from Medicare appellants in a professional, timely, and accurate manner, including writing letters and proofreading according to current guidelines.
Research and identify claims-processing deficiencies and initiate corrective responses.
Evaluate the documentation and history needed to determine whether cases meet policy criteria, ensuring accurate and compliant processing in accordance with Centers for Medicare & Medicaid Services (CMS) guidelines.
Submit educational referrals as necessary to decrease redeterminations and allow claims to pay at the lowest level of appeal.
Assist in writing and updating processing guidelines.
Identify internal and external education or training needs, communicate findings, and assist with training when necessary.
Communicate information to appropriate internal and external parties in a timely manner.
Problem-solve and conduct research effectively.
Process 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.
Maintain knowledge of CMS and Joint Operating Agreement requirements.
At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.
Redetermination Examiner
Rate: $22/Hour
Temporary 6 month role
Training will be provided
100% Remote
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, 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
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.
Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.
Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).
The pay range shown is a good-faith estimate of the compensation Broadway Ventures reasonably expects to pay for this position at the time of posting. It is not a guarantee of any particular wage, salary, or total compensation. Actual pay offered depends on job-related factors, which may include skills, experience, education, certifications and licensure, geographic work location, contract funding and budget. For positions covered by the Service Contract Act, pay is also governed by the applicable Department of Labor wage determination, which the government may revise.
Location Eligibility: Broadway Ventures cannot consider applicants who live in, or would work from, any of the following locations: California, Colorado, Connecticut, the District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, New York, North Dakota, Ohio, Oregon, Rhode Island, Washington State, and Wyoming. Candidates must live in and work from an eligible U.S. state when they are hired and for as long as they are employed. Applications from residents of the locations listed above will not be considered.
Notice: Use of Artificial Intelligence in Our Hiring Process
Broadway Ventures uses an artificial intelligence (AI) tool to help review applications for this position.
Who built it: Broadway Ventures developed the tool in-house.
What it does: It compares your resume to the requirements in this job posting and gives a score from 0 to 100 showing how closely your qualifications match.
What information it uses: The text of your resume, your name, your current or most recent job title, your location, and this job posting.
What it cannot see: Your answers to voluntary demographic or equal employment opportunity questions, interview feedback, or offer information.
How it is used: The score is one factor in our initial review of applications. The tool does not reject anyone. A member of our recruiting team reviews every application before any decision is made.
Your options: If you would like your application reviewed without the AI tool, or you need a reasonable accommodation at any point in the hiring process, contact us at [email protected]. Making a request will not affect whether you are considered for this position.
Some positions are posted in support of a contract proposal that has not yet been awarded. Where that is the case, the position and its final compensation are contingent upon award of the contract to Broadway Ventures and on the terms of the awarded contract, including any government-approved labor rates and the applicable wage determination.
Broadway Ventures offers a comprehensive benefits package. A general description of benefits is below.
401(k) and company match
PTO that grows the longer you stay
Health, Vision, Dental
Company provided Life Insurance and Voluntary Life Insurance