Redetermination Examiner, Medicare, DME

Job not on LinkedIn

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $22 / hour

⏳ Contract/Temporary

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Simsy Ventures

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2022

💼 Consulting

📣 Marketing

🏥 Healthcare

Consulting • Marketing • Healthcare

Simsy Ventures is a venture builder and institutional co-founder that partners with entrepreneurs, investors, and corporations to create sustainable startups. Their mission focuses on enabling startups to achieve true potential while promoting a positive impact on profits, people, and the planet. With a structured approach, they support startups throughout their lifecycle, from ideation to market validation and growth. By leveraging a repeatable venture studio model, Simsy Ventures aims to uplift economies globally through impactful entrepreneurship.

📋 Description

• Conduct redetermination reviews per Medicare rules and regulations • Respond to incoming appeals from Medicare appellants professionally, timely, and accurately • Write and proofread letters according to current guidelines • Research and identify claims processing deficiencies and initiate corrective responses • Evaluate documentation and history against policy criteria for accurate, CMS-compliant processing • 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/external education and training needs, communicate findings, and assist in training as needed • Communicate information to appropriate internal and external parties • Problem-solve and research effectively • Process overpayment appeals as needed • Maintain up-to-date knowledge of working systems, processing instructions, and relevant resources • Maintain knowledge of CMS and Joint Operating Agreement requirements

🎯 Requirements

• High School Diploma or GED • 6 months’ work-related experience • General PC knowledge • Strong prioritization, analytical and communication skills • Ability to adapt to changes • Candidates must live in and work from an eligible U.S. state when they are hired and for as long as they are employed • Broadway Ventures conducts background checks and drug testing prior to the start of employment • Some positions may also require fingerprinting

🏖️ Benefits

• 401(k) and company match • PTO that grows the longer you stay • Health, Vision, Dental • Company provided Life Insurance and Voluntary Life Insurance • Short Term Disability and Long Term Disability • Training will be provided

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