Redetermination Examiner (Medicare, Part B) (6 Month Temp)
Core
Conducts redetermination reviews and responds to incoming appeals for Medicare Part B claims in accordance with CMS guidelines.
Role type
Claims examiner (Medicare appeals)
Builds
Accurate claim processing and compliant appeal responses for Medicare beneficiaries
Domain
Healthcare administration / Medicare compliance
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Analytical skills, attention to detail, research capabilities, prioritization, PC proficiency
Preferred skills
Ability to adapt to changes, communication skills
Technologies
CMS guidelines, Medicare rules, PC systems
Responsibilities
Conduct redetermination reviews per Medicare rules, respond to incoming appeals, research claims processing deficiencies, evaluate documentation against policy criteria, submit educational referrals, assist in updating processing guidelines, process overpayment appeals
Seniority
Entry-level, temporary