Redetermination Examiner

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $17 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

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Baltimore Aircoil Company

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

🏭 Manufacturing

⚡ Energy

Manufacturing • Energy • HVAC

Baltimore Aircoil Company is a manufacturer specializing in cooling and heating systems tailored for various industrial applications. They provide high-quality equipment, parts, and inspection services to enhance operational efficiency in temperature control solutions. Their commitment to customer support and product innovation positions them as a reliable partner in the HVAC and industrial sectors.

📋 Description

• Examine incoming Medicare redetermination appeals by reviewing documentation, claim history, and applicable guidelines • Conduct redetermination reviews in accordance with Medicare rules, regulations, and established guidelines • Determine whether adjustments within standard systems are appropriate • Respond to Medicare appellants professionally, timely, and accurately • Prepare, proofread, and issue correspondence according to current guidelines • Research and identify claims processing deficiencies and initiate corrective responses • Evaluate documentation, claim history, and policy criteria for accurate and compliant appeal processing • Submit educational referrals to reduce redeterminations and support claims resolution at the lowest appropriate appeal level • Assist with writing, reviewing, and updating processing guidelines • Identify internal or external education and training needs and assist with training • Communicate information to appropriate internal and external parties • Research issues, analyze information, and solve problems • Process overpayment appeals as assigned • Maintain current knowledge of working systems, processing instructions, CMS requirements, Joint Operating Agreement requirements, and relevant resources • May coordinate work activities, provide workload guidance, and support training or reporting activities • Perform other duties and special projects as assigned • No overnight or out-of-area travel expected; local movement within local sites required for inspections, meetings, incident response, and contract operations

🎯 Requirements

• High School Diploma or equivalent • Minimum of six (6) months of work-related experience • Must successfully pass all required pre-employment screenings, including a drug screening • Ability to obtain and maintain required access approvals, credentials, or background clearances applicable to the assigned contract or work location • Experience with Medicare claims, appeals processing, healthcare administration, customer service, or records review preferred • General PC knowledge and ability to work within standard business systems • Strong prioritization, analytical, and communication skills • Ability to adapt to changes in guidelines, systems, workloads, and business needs • Ability to review documentation and apply policies, procedures, and guidelines accurately • Ability to prepare clear, accurate, and professional written correspondence • Ability to research issues, identify deficiencies, and recommend corrective responses • Ability to maintain confidentiality and handle sensitive information appropriately • Strong attention to detail and commitment to quality and compliance • Must be able to perform established essential functions, with or without reasonable accommodation • Must be able to sit or stand for extended periods and perform computer-based work • Must be able to use hands and fingers for keyboarding, data entry, document review, and office tasks • Must be able to view computer screens, reports, electronic records, and written materials for extended periods • Must be able to communicate verbally and in writing with supervisors, coworkers, customers, and stakeholders • Must be able to lift, carry, or move standard office materials and equipment weighing up to 25 pounds • Must comply with company safety policies, information security requirements, confidentiality standards, and established procedures

🏖️ Benefits

• Free medical, dental, and vision insurance for employees • Medical opt-out plan available for qualified employees • Paid holidays and sick time • Paid vacation available after one year of employment, based on hours worked • 401(k) plan eligibility for full-time employees on the first of the month following date of hire • Supplemental benefits, including Accident, Critical Illness, Short Term Disability, and Hospital • Employee Assistance Program • Remote work option