Appeals Specialist
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 will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.
Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.
Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).
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