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Medicare Audit & Appeals Supervisor

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Baxter

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Location:
United States , Saint Paul

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Category:
-

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Contract Type:
Employment contract

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Salary:

68000.00 - 93500.00 USD / Year
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Job Description:

As the Medicare Audit & Appeals Supervisor for Baxter Respiratory Health team, you will be responsible for supervising employees in the Revenue Cycle Management function, resolving individual account issues, and overseeing Medicare Audits and Appeals. The role involves staff management, mentorship, monitoring workloads, and streamlining processes to ensure quality objectives are met.

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
  • Prepare and submit persuasive appeal request to Medicare (determination, Reconsiderations and Administrative Law Judge (ALJ))
  • Collaborate with supervisory team to ensure consistency in communications and procedures across Payer, Customer, Operations, Revenue Cycle Management
  • Identify and develop new processes and streamline existing workflows
  • Maintain daily, positive communication with other departments
  • Answer questions and aid new and existing team members
  • Coordinate problematic accounts with management
  • Coordinate teamwork and ensure quality objectives and work deadlines are being met
  • Act as a liaison to other departments related to payer or patient-specific issues
  • Maintain understanding of department policies and procedures
  • Perform other duties and projects as assigned.

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
  • Proficiency in Microsoft Office Software
  • Exceptional written, verbal, interpersonal communications and presentation skills
  • Detail orientation
  • Ability to work independently, multi-task and manage workload
  • Experience with TIMS and Waystar/E-Solutions Clearinghouse preferred.

Nice to have:

  • Knowledge of the various contractors Medicare Fee for Service audits
  • Knowledge of Medicare Regulations
  • Experience with Third Party Compliance
  • Experience with Durable Medical Equipment provider
  • Six Sigma Green Belt
  • Experience with TIMS and Waystar/E-Solutions Clearinghouse.
What we offer:
  • Medical and dental coverage starting 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)
  • 401(k) Retirement Savings Plan with 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
  • Commuting benefits
  • Employee Discount Program
  • Employee Assistance Program (EAP)
  • Childcare benefits.

Additional Information:

Job Posted:
March 21, 2025

Employment Type:
Fulltime
Work Type:
On-site work
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