Redetermination Examiner (Medicare, DME)
New
B
Broadway VenturesMedicare Administration
United StatesContractJunior
Salary22 USD per hour
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Job Details
- Experience
- 6 months’ work-related experience
- Required Skills
- Analytical Skills
Requirements
- High School Diploma or GED.
- 6 months of work-related experience.
- General PC knowledge.
- Strong prioritization skills.
- Strong analytical skills.
- Strong communication skills.
- Ability to adapt to changes.
- Ability to maintain knowledge of CMS and Joint Operating Agreement (JOA) requirements.
Responsibilities
- Conduct redetermination reviews per Medicare rules and regulations.
- Respond to incoming appeals from Medicare appellants in a professional, timely, and accurate manner, including letter writing and proofreading.
- Research and identify claims processing deficiencies and initiate corrective responses.
- Evaluate documentation and history against policy criteria to ensure compliant processing per CMS guidelines.
- Submit educational referrals to decrease redeterminations.
- Assist in writing and updating processing guidelines.
- Identify internal/external training needs and assist in training if necessary.
- Process overpayment appeals as needed.
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