Medicare Redetermination Examiner

Job Summary

Examining incoming Medicare Redetermination appeals, the full-time remote Medicare Redetermination Examiner will review documentation to make determinations, ensure compliance with CMS regulations, and respond to appeals with a focus on quality customer service.

Key responsibilities

• Conduct redetermination reviews in accordance with Medicare rules and regulations
• Respond to appeals from Medicare appellants in a professional and timely manner, including letter writing and proofreading
• Research claims processing deficiencies and initiate corrective actions as needed

Required qualifications

• High School diploma or GED
• At least 6 months of relevant work experience
• General PC knowledge
• Prioritization skills
• Knowledge of medical terminology and claims processing timelines