Medical Review II (Medicare)
Perform complex medical reviews of Medicare claims for Inpatient Rehabilitation Facility services. Conduct pre-claim review determinations and communicate findings directly to providers.
Broadway Ventures
Remote Job Openings at Broadway Ventures (14)
Junior Recruiter- Healthcare (Remote)
The Junior Recruiter will manage full-cycle hiring for clinical and non-clinical healthcare roles, including sourcing, screening, and coordinating interviews. They will also maintain candidate pipelines and ensure accurate recordkeeping within the applicant tracking system.
Recruiter - Federal Health Programs
The recruiter will consult with leadership to identify and evaluate qualified clinical and technical talent for federal contracts and internal growth. Responsibilities include sourcing candidates, managing the interview process, and coordinating with stakeholders to support proposal-driven hiring efforts.
Project Controller
The Project Controller will lead federal project delivery for CMS, HHS, and DoD clients by managing audit, compliance, and performance oversight engagements. They will serve as the primary interface with government stakeholders, maintaining project plans and reporting on progress.
Project Coordinator
The Project Coordinator will manage day-to-day project activities, schedules, and deliverable timelines across a portfolio of government contracts. They are responsible for maintaining project documentation, facilitating communication between stakeholders, and supporting compliance reporting and proposal development.
Redetermination Examiner (Medicare, Part B) (6 Month Temp)
The Redetermination Examiner conducts Medicare redetermination reviews and processes appeals in accordance with CMS guidelines. They are responsible for identifying claims processing deficiencies, maintaining accurate documentation, and providing educational referrals to ensure compliant outcomes.
Remote Medical Reviewer (Medicare- Home Health)
The Medical Reviewer will evaluate complex claims, pre-authorization requests, and appeals to ensure medical necessity and accurate reimbursement. They will also provide clinical rationales for coverage determinations and support quality control initiatives.
Appeals Support Specialist (Medicare, DME) (6 Month Temp)
The Appeals Support Specialist is responsible for managing and prioritizing workloads while accurately recording and indexing documentation in the OnBase system. They also coordinate with external stakeholders to order necessary documentation and communicate process trends to management.
Appeals Support Specialist (Medicare, Part B) (6 Month Temp)
The Appeals Support Specialist is responsible for managing and prioritizing workloads while accurately recording and indexing documentation in OnBase. They will also communicate with management regarding process trends and improvements.
Redetermination Examiner (Medicare, DME) (6 Month Temp)
The Redetermination Examiner conducts reviews of Medicare claims and responds to appeals in accordance with CMS regulations. They are responsible for identifying processing deficiencies, maintaining accurate documentation, and providing educational support to ensure compliant claim outcomes.
Provider Enrollment Specialist
The Provider Enrollment Specialist is responsible for reviewing, researching, and processing medical provider enrollment applications to ensure accuracy and compliance. They also manage provider data in internal databases and communicate with various stakeholders to resolve discrepancies.
Claims Rep II – GHA Redetermination Rep
The role involves reviewing and responding to Medicare redetermination requests by analyzing medical documentation, coding, and policy guidelines. You will also collaborate with medical staff to determine claim outcomes and ensure accurate financial liability and decision letters.
Medical Claim Reviewer (CGS, DMEC)
Conduct pre- and post-payment medical reviews to ensure compliance with clinical criteria and guidelines. Assess medical necessity and reimbursement eligibility for complex claims, appeals, and fraud referrals.
Physician, Medical Case Reviewer (Remote, Part-Time, Flexible Hours)
The physician will conduct independent medical case reviews to assess quality of care and adherence to standards. They will also provide expert medical opinions and identify opportunities for improvement.