At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.
The Redetermination (Appeals) Specialist supports the Medicare Appeals team by performing non-medical reviews, preparing redetermination letters, and ensuring timely and accurate processing. This role requires strong organizational skills, attention to detail, and the ability to work with reports, documentation, and multiple software tools in a fast-paced environment.
Key Responsibilities
- 50% – Perform non-medical reviews and process redetermination letters, ensuring accuracy and compliance with established timelines.
- 30% – Prepare unit reports, analyze and interpret workload data, and address processing issues using various software tools.
- 10% – Update letters, templates, and departmental documents as needed.
- 10% – Gather and prepare documentation for legal inquiries and administrative requests.
Education Requirements
- High School Diploma or equivalent required.
- Associate’s or Bachelor’s degree preferred.
Work Experience
- Minimum of 2 years of relevant experience in healthcare, insurance, or Medicare/Medicaid services.
- Customer service experience preferred.
- Medicare-specific experience preferred but not required; comprehensive training provided.
Skills & Abilities
- Proficiency with Microsoft Office (Word, Excel, Outlook).
- Strong organizational skills with excellent attention to detail.
- Effective written and verbal communication skills.
- Demonstrated ability to exercise sound judgment and handle confidential information.
- Strong spelling, grammar, and punctuation skills.
Work Environment
- Remote, work from home
- M-F, 40 hours a week
Benefits
- 401(k) & matching
- Dental insurance
- Vision insurance
- Health insurance
- Life insurance
- Paid Time Off (PTO)
- Paid Holidays
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and discuss salary requirements. Management will be conducting interviews with the most qualified candidates. We perform a background and drug test prior to the start of every new hires' employment. In addition, some positions may also require fingerprinting.
Broadway Ventures is an equal-opportunity employer and a VEVRAA Federal Contractor committed to providing a workplace free from harassment and discrimination. We celebrate the unique differences of our employees because they drive curiosity, innovation, and the success of our business. We do not discriminate based on military status, race, religion, color, national origin, gender, age, marital status, veteran status, disability, or any other status protected by the laws or regulations in the locations where we operate. Accommodations are available for applicants with disabilities.
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