Claims Rep II – GHA Redetermination Rep
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.
Total comp value: $22/hr
Respond to requests for first-level appeals. Review and compare processed claims with edit/audit detail and Medicare Policy. Refer case to appeal nurse for medical necessity determination. Review medical documentation and claims history for frequency of service, required coding elements, and accurate fee determinations. Complete decision letters or claim adjustments as required to effectuate first level of appeal decisions. Establish and maintain a professional rapport with contacts and present a favorable corporate image.
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