Redetermination Examiner, Medicare Part B – 6 Month Temp

Simsy Ventures

. Conduct redetermination reviews per Medicare rules and regulations .

Posted 10/31/2026contractRemote • United StatesJunior💰 $22 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting Medicare redetermination reviews and responding to appeals while maintaining compliance with CMS guidelines. Strong analytical and communication skills are essential for evaluating documentation and providing training support.

Highest-signal resume keywords

Medicare Rules And RegulationsClaims ProcessingAnalytical SkillsCommunication SkillsDocumentation Evaluation

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Redetermination ReviewsClaims Processing DeficienciesProcessing GuidelinesOverpayment AppealsEducational Referrals

Soft Skills

Strong PrioritizationAdaptabilityProblem Solving

Tools & Technologies

General PC Knowledge

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

CMS GuidelinesJOA RequirementsMedicare AppealsDocumentation History

About the role

Key responsibilities & impact

Conduct redetermination reviews per Medicare rules and regulations
Respond to Medicare appeals professionally, timely, and accurately
Write and proofread letters according to current guidelines
Research claims processing deficiencies and initiate corrective responses
Evaluate documentation and history against policy criteria and CMS guidelines
Submit educational referrals to reduce redeterminations
Assist in writing and updating processing guidelines
Identify education and training needs and assist with training
Communicate information to internal and external parties
Process overpayment appeals as needed
Maintain current knowledge of systems, processing instructions, CMS, and JOA requirements
Research and solve problems effectively

Requirements

What you’ll need

High School Diploma or GED
6 months’ work-related experience
General PC knowledge
Strong prioritization, analytical and communication skills
Ability to adapt to changes
Candidates must live in and work from an eligible U.S. state when hired and throughout employment
Must pass background checks and drug testing prior to employment; some positions may require fingerprinting

Benefits

Comp & perks

401(k) and company match
PTO that grows the longer you stay
Health, Vision, Dental
Company provided Life Insurance and Voluntary Life Insurance
Short Term Disability and Long Term Disability