Redetermination Examiner (Medicare, DME) (6 Month Temp)
Core
Conducts redetermination reviews and appeals processing for Medicare claims, ensuring compliance with CMS guidelines and identifying claims processing deficiencies.
Role type
Medicare claims redetermination examiner
Builds
Accurate Medicare claim adjudication and compliant processing outcomes
Domain
Healthcare administration / Medicare compliance
Required skills
Analytical skills, attention to detail, research capabilities, prioritization, PC proficiency
Preferred skills
Knowledge of CMS guidelines, experience with appeals processing
Technologies
General 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 role