Medicare Audit & Appeals Supervisor Job at Baxter (Saint Paul)

Medicare Audit & Appeals Supervisor

Supervise employees in the Revenue Cycle Management function while acting as a r...

Location

United States , Saint Paul

Salary:

5666.67 - 7791.67 USD / Month ▼

Baxter

Expiration Date

Until further notice

Requirements

Respiratory Therapist (RT), Licensed Practical Nurse (LPN), or Registered Nurse (RN) or Paralegal required
Current professional licensure or certification as required by the state of residence
3+ years’ experience in Medicare Audits, Medical Claims, Appeals or Third-Party Reimbursement
1+ years leadership or supervisory experience
Strong critical thinking and problem-solving skills
Knowledge of the various contractors Medicare Fee for Service audits, preferred
Knowledge of Medicare Regulations preferred
Experience with Third Party Compliance preferred
Experience with Durable Medical Equipment provider preferred
Six Sigma Green Belt preferred

Job Responsibility

Directly supervise assigned staff, including on-going performance feedback
Apply corrective measures as appropriate to ensure standards are maintained and goals are achieved
Provide work direction and content expertise to direct reports
Supervise medical reimbursement including Clinical Review for coverage and Medicare Appeals
Prepare and submit pre- and post-payment Audits to Medicare programs
Evaluate and process daily adjustment requests as needed
Assist staff in career development and training
Provide training and mentorship to new team members
Monitor workloads, including daily performance metrics, overdue activities and pending files
Identify and resolve issues on complex patient files

What we offer

Medical and dental coverage starting on day one
Basic life insurance
Accident insurance
Short-term and long-term disability insurance
Business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan with company matching
Flexible Spending Accounts
Educational assistance programs
Paid holidays

Fulltime

Lead Customer Solution Center Appeals and Grievances RN

The Lead Customer Solution Center Appeals and Grievances RN is responsible for a...

Location

United States , Los Angeles

Salary:

102183.00 - 163492.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing for Registered Nurses
At least 8 years of clinical appeals and grievances experience in a managed care, utilization management and/or case management setting
At least 2 years in Medicare/ Medicaid in a managed care/ health plan environment
At least 1 year of leading a process, program, or staff experience
Extensive knowledge of healthcare regulations and managed care guidelines
Strong critical thinking and problem-solving abilities to assess complex clinical cases and evaluate medical necessity
Ability to communication, conflict resolution, and motivational skills
Ability to work independently and closely with a team in a collaborative and interactive environment
Ability to adjust to changing circumstances within the team
Good verbal and written communication skills

Job Responsibility

Assist with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit
Quality review of complex and/or escalated clinical A&G cases for all line of business (LOB)
Assist in identifying areas of improvement in increasing positive audit outcomes and improved Customer Service
Ensure the effective investigation and resolution of clinical grievances, appeals, complaints, and complex issues in alignment with L.A. Care policy and procedures and regulatory guidelines
Lead and work closely with assigned team daily
Mentor, coach, and may provide feedback to management on performance of staff
Review and process complex and/or escalated clinical A&G cases
Analyze patient medical records, clinical documentation, and insurance policies to determine medical necessity
Prepare and review A&G files for submission to providers and internal departments
Work with other departments to ensure all aspects of a case are appropriately managed

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Reimbursement Supervisor

The Reimbursement Supervisor, is responsible for overseeing reimbursement activi...

Location

United States , Frisco

Salary:

Not provided

Arcadia Home Care and Staffing - an Addus family company

Expiration Date

Until further notice

Requirements

High School Diploma or GED
Three to five years of previous supervisory experience preferred
Comprehensive knowledge of reimbursement guidelines (specifically Medicaid, Managed Care and Long Term Care insurance)
Comprehensive knowledge of electronic transmissions of billing, cash posting and/or insurance verification
Solid history of proven success with Revenue Cycle Supervision (admissions, billing, collections and/or cash applications)
Advanced computer proficiency including Microsoft office
Ability to create and manage excel spreadsheets
Excellent customer service skills
Excellent verbal and written communication skills
High level interest in being part of a dynamic and growing team

Job Responsibility

Supervise reimbursement activities at the Support Center for multiple branch locations and payers as it relates to admissions, insurance verification, authorization, billing, collections, cash management and/or other operations related to the revenue cycle process
Supervise and train Support Center and branch personnel as it relates to revenue cycle activities
Assist in recruiting of new personnel
Monitor and supervisor revenue cycle team of 10-15 employees
Supervise adherence to departmental operating procedures to ensure efficient, compliant and profitable operations
Supervise staff to drive to key metrics
Keeps abreast of payer guidelines and changes to these guidelines. Notify all affected personnel of these changes. Assist in implementation of these changes
Analyze and trend key data to improve overall performance
Implement efficiencies within department including, but not limited to: new electronic claim transmission, electronic funds transfer, and electronic eligibility verification
Assist in recommending, establishing and implementing new reimbursement policies and procedures to drive improvement

What we offer

Medical, Dental and Vision Benefits
Continued Education
PTO Plan
Retirement Planning
Life Insurance
Employee discounts

Fulltime

New

Production Operator Fill

This is where my hands make life-sustaining products. You are driven by the know...

Location

United States , Round Lake

Salary:

28.20 USD / Hour

Baxter

Expiration Date

Until further notice

Requirements

Must not be allergic to Penicillin or Cephalosporin Drugs
High School Diploma or equivalent is required, experience in GMP Mfg
Visual acuity 20/25 Near Vision with or without corrective vision required
Must be able to understand, speak, read and write English in order to align with vital SOP’s, SPEC’s, Job-specific training materials, GMP’s, and other manuals
Requires the use of and troubleshooting of the label and directional insert dispensing equipment
Preferably 6+ months of experience with technical/mechanical machine operating
Good documentation skills and computer skills
Basic math skills required
Candidates will be required to pass a job placement examination which test the physical capabilities to perform the certain functions of a job
Comfortable to wear protective equipment with a respirator, and work in confined spaces

Job Responsibility

Run Galaxy Machine
Set up equipment
Perform sterilization
Management of Datalogger output
Troubleshoot alarms
Performing tasks related to the operation of different equipment used in the mix and fill process, which may include the use of tools like calipers, scales, gauges, and other measuring devices
Make process adjustment in accordance with GMP’s and Plant Procedures
Responsible for In-Process inspections and all related documentation in accordance to specifications
Issue ports, build embosser, clean pressure vessel
Perform line clearances

What we offer

medical and dental coverage that start on day one
insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Employee Stock Purchase Plan (ESPP), with the ability to purchase company stock at a discount
401(k) Retirement Savings Plan (RSP), with options for employee contributions and company matching
Flexible Spending Accounts
educational assistance programs
paid holidays
paid time off ranging from 20 to 35 days based on length of service
family and medical leaves of absence
paid parental leave

Fulltime

New

Pharmacy Technician

We’re building a world of health around every individual — shaping a more connec...

Location

United States , Whittier

Salary:

19.46 USD / Hour

CVS Health

Expiration Date

May 19, 2026

Requirements

Must comply with any state board of pharmacy requirements or laws governing the practice of pharmacy, which includes but is not limited to, age, education, and licensure/certification
If the state board of pharmacy does not address or mandate a minimum age requirement, must be at least 16 years of age
If the state board of pharmacy does not address or mandate a minimum educational requirement, must have a high school diploma or equivalent, or be actively enrolled in high school or high school equivalency program
Regular and predictable attendance, including nights and weekends
Ability to complete required training within designated timeframe
Attention and Focus: Ability to concentrate on a task over a period of time
Ability to pivot quickly from one task to another to meet patient and business needs
Ability to confirm prescription information and label accuracy, ensuring patient safety
Customer Service and Team Orientation: Actively look for ways to help people, and do so in a friendly manner
Notice and understand patients’ reactions, and respond appropriately

Job Responsibility

Living our purpose by following all company SOPs at each workstation to help our Pharmacists manage and improve patient health
Following pharmacy workflow procedures at each pharmacy workstation (i.e., production, pick-up, drive-thru, and drop-off) for safe and accurate prescription fulfillment
Contributing to positive patient experiences by showing empathy and genuine care: creating heartfelt and personalized moments while serving patients at pick-up, drive-thru, and over the phone
keeping patients healthy by offering immunizations and other services at the register and over the phone
and demonstrating compassionate care by solving or escalating patient problems
Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team, such as accurately putting away medication deliveries and completing cycle counts, returns-to-stocks, waiting bin inventories, etc.
Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
actively seeking opportunities to expand clinical and technical knowledge needed to better assist patients
Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
voluntarily traveling to stores in the market to work shifts as needed by the business

What we offer

Affordable medical plan options
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Parttime

New

F&B Service Expert

Our jobs aren’t just about putting food on the table that our guests will enjoy ...

Location

Spain , Barcelona

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

High school diploma or G.E.D. equivalent
Less than 1 year related work experience
No supervisory experience
No license or certification required
Ability to create a safe workplace
Ability to follow company policies and procedures
Ability to uphold quality standards
Professional uniform, personal appearance, and communications
Ability to stand, sit, or walk for an extended time
Ability to move over sloping, uneven, or slippery surfaces

Job Responsibility

Building an experience that is memorable and unique
Taking the initiative and delivering a wide range of services to make sure guests enjoy their meal
Setting tables
Communicating with the kitchen
Interacting and serving guests
Cleaning work areas and supplies
Making transactions feel like part of the experience
Doing other reasonable job duties as requested

Fulltime

New

Prosthodontist

Looking for a new challenge with a supportive, forward-thinking team? Join us in...

Location

United Kingdom , Stafford

Salary:

67500.00 - 150000.00 GBP / Year

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

GDC registration + performer number
Indemnity cover
Eligibility to work in the UK

Job Responsibility

Provide essential dental care to patients
Offer additional treatments and services to support oral health needs

What we offer

50% private/lab fee split
Modern and spacious 6 surgery practice
Intraoral scanner available
Digital x-rays available
Longstanding and established staff
Book build up
Specialist onsite - Implantologist and Aligners
Specialist Nurses onsite - Radiography, Impressions, Implants
Stafford town centre 5 mins walk away
Easy access to public transport

Fulltime

New

Mobile Associate - Retail Sales

This role supports retail operations by engaging customers and facilitating thei...

Location

United States , Jackson

Salary:

18.00 USD / Hour

T-Mobile

Expiration Date

Until further notice

Requirements

High School Diploma/GED
6 months of customer service and/or sales experience, Retail environment (Preferred)
Passionate customer advocate with the desire to be yourself when connecting and having fun doing it
Competitive drive and proven ability to succeed in a fast-paced sales environment
Willingness to work alongside peers and store leaders, learning and sharing ideas, while serving customers and providing resolutions to issues
Effective at balancing customer needs and performance goals
At least 18 years of age
Legally authorized to work in the United States

Job Responsibility

Develop proficiency in customer service and sales to deliver personalized technology and service solutions that meet individual needs
Utilize digital tools to demonstrate network coverage, service plans, and product features to enhance customer understanding and engagement
Complete required training to build knowledge of retail processes, systems, and wireless technology innovations
Collaborate with colleagues across channels to support a seamless customer experience and contribute to team initiatives
Also responsible for other duties/projects as assigned by business management as needed

What we offer

Annual stock grant
Employee stock purchase plan
401(k)
Access to free, year-round money coaches
Medical, dental and vision insurance
Flexible spending account
Paid time off and up to 12 paid holidays
Paid parental and family leave
Family building benefits
Back-up care

Parttime

Medicare Audit & Appeals Supervisor

Baxter

Location:
United States , Saint Paul

Category:
-

Contract Type:
Employment contract

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
March 21, 2025

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