BROADWAY VENTURES, LLC
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, weāre more than a service providerāweāre your trusted partner in innovation.
Broadway Ventures, LLC is seeking a Remote Appeals Nurse (RN) to join our growing team. In this fully remote role, you will review medical records and claims to determine whether services meet Medicare coverage and medical necessity requirements. This role is ideal for a detail-oriented and experienced nurse who excels in documentation review and is passionate about ensuring accurate and fair healthcare adjudication.
Minimum Qualifications: Associateās (ASN) or Bachelorās (BSN) Degree in Nursing Active, unrestricted RN license in your state of residence/practice U.S. residency for at least 3 of the last 5 years Willingness to undergo and pass federal background screenings Preferred Qualifications: 4+ years of clinical nursing experience, including roles outside direct patient care Experience in Medical Management, Medical Review, Utilization Review, or Appeals Familiarity with Medicare Part A and Part B policies and procedures Prior experience working in a remote environment Previous work with a Medicare Administrative Contractor (MAC) is a plus Strong technical writing and communication skills Proficiency with Microsoft Office tools (Outlook, Teams, OneNote, Word, Excel) and ability to manage multiple online systems Remote Work Requirements: A private, dedicated home workstation Wired Ethernet internet connection (satellite internet and mobile hotspots not permitted) Internet speed of at least 10 Mbps download / 1 Mbps upload (testable at speedtest.net) Work Hours and Training: Regular work schedule falls between 6:00 AM ā 6:00 PM Central, Monday through Friday Training is typically conducted Monday through Friday, 8:00 AM ā 4:00 PM Central, though times may vary slightly
Conduct first-level appeal reviews to assess the medical necessity and compliance of services with Medicare guidelines Use clinical knowledge and professional judgment to evaluate claim documentation Write concise, well-supported explanations for decisions regarding claims Collaborate with internal team members to ensure appeal decisions are completed accurately and within expected timelines Identify high-volume or recurring issues and escalate findings to leadership Participate in quality improvement initiatives and contribute to consistent review practices
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