<div class="content-intro"><div class="et_pb_module et_pb_text et_pb_text_0 et_pb_text_align_left et_pb_bg_layout_light"> <div class="et_pb_text_inner"> 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. </div> </div></div>Redetermination Examiner <ul> <li>Rate: $22/Hour</li> <li>Temporary 6 month role</li> <li>Training will be provided</li> <li>100% Remote</li> </ul> Key Duties/Responsibilities/Accountabilities: <ul> <li>Conducts redetermination reviews per Medicare rules and regulations.</li> <li>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.</li> <li>Researches and identifies claims processing deficiencies and initiates corrective response.</li> <li>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.</li> <li>Submits educational referrals as necessary to decrease redeterminations and allow claims to pay at the lowest level of appeal.</li> <li>Assists in writing and updating processing guidelines.</li> <li>Identifies internal/external education and/or training needs, communicates findings, and assists in training if necessary.</li> <li>Communicates information to appropriate internal and external parties in a timely manner.</li> <li>Problem solves and researches effectively.</li> <li>Processes overpayment appeals as needed.</li> <li>Maintain up-to-date knowledge of working systems, processing instructions, and other relevant resources to ensure efficient and accurate appeal processing.</li> <li>Maintains knowledge of CMS and Joint Operating Agreement (JOA) requirements</li> </ul> Minimum Qualifications: <ul> <li>High School Diploma or GED</li> <li>6 months’ work-related experience</li> </ul> Proficiencies: <ul> <li>General PC knowledge</li> <li>Strong prioritization, analytical and communication skills</li> <li>Ability to adapt to changes</li> </ul><div class="content-conclusion"> 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 oppor

Redetermination Examiner (Medicare, Part B) (6 Month Temp)

Job Description