Contract
Redetermination Examiner
Medicare, DME
Broadway Ventures
Compensation Overview
$22/hr
Remote in USA
Remote
Category
 Administrative & Executive Assistance (1) |
|---|
Requirements
- A High School Diploma or GED is required.
- Six months of work-related experience is required.
- General personal computer knowledge is required.
- The role requires prioritization, analytical, and communication skills.
- The ability to adapt to changes is required.
Responsibilities
- Conduct redetermination reviews according to Medicare rules and regulations.
- Respond to incoming appeals from Medicare appellants in a professional, timely, and accurate manner, including letter writing and proofreading according to current guidelines.
- Research and identify claims-processing deficiencies and initiate corrective responses.
- Evaluate documentation and history against policy criteria to ensure accurate and compliant processing in accordance with Centers for Medicare & Medicaid Services 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.
- Solve problems 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 Centers for Medicare & Medicaid Services and Joint Operating Agreement requirements.