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

Medicare Audit & Appeals Supervisor

As the Medicare Audit & Appeals Supervisor for Baxter Respiratory Health team, y...

Location

United States , Saint Paul

Salary:

68000.00 - 93500.00 USD / Year

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
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

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

New

Lead Customer Solution Center Appeals and Grievances RN

The Lead Appeals and Grievances RN is responsible for assisting with the develop...

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
Demonstrated ability to provide recommendations towards resolution
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

Job Responsibility

Review and process complex and/or escalated clinical A&G cases
Analyze the patient medical records, clinical documentation, and insurance policies to determine medical necessity
Prepares and reviews A&G files for submission to providers and internal departments
Work with other departments to ensure all aspects of a case are appropriately managed
Conduct targeted and random clinical case audits to ensure that all regulatory and departmental guidelines, policies, procedures, and standards are met
Work closely with the leadership team to create and/or modify Desk Level Procedures and recommend enhancements to process and procedures
Assist the Clinical Supervisors in identifying deviations in performance and process changes are implemented to redirect performance to acceptable levels
Recommend and implement resolutions, new processes, and/or process improvement
Provide accurate and timely written statistical reports that include historical and/or current data to aid in projecting or evaluating compliance status
Identify and analyze trends in appeals and grievances to find the root cause of denials

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

Mgr-Restaurant

Plays a significant role in maximizing financial performance and attracting hote...

Location

Georgia , Batumi

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

H High school diploma or GED
4 years experience in the food and beverage, culinary, or related professional area
2-year degree from an accredited university in Food Service Management, Hotel and Restaurant Management, Hospitality, Business Administration, or related major
2 years experience in the food and beverage, culinary, or related professional area

Job Responsibility

Plays a significant role in maximizing financial performance and attracting hotel and non-hotel guests by understanding the local market and partnering with the culinary leadership to effectively position the outlet
Supervises daily restaurant operations and assists with menu planning, maintains sanitation standards and assists servers and hosts on the floor during peak meal periods
Strives to continually improve guest and employee satisfaction
Determines training needed to accomplish goals, then implements plan
Understands financial opportunities by surveying restaurant demand
Partners with key individuals in the local community to assess opportunities
Identifies and analyzes competitors
Controls purchases and inventory by negotiating prices and contracts, developing preferred supplier lists, reviewing and evaluating usage reports, and taking corrective action
Applies sound revenue management strategies to secure the right level of business at the most optimal time to yield maximum revenues
Oversees the restaurant marketing plan in partnership with the either the Hotel General Manager/ Manager or Director of Operations and Hotel/Brand Marketing teams including Destination Restaurant Chef, if applicable

Fulltime

New

Housekeeping Room Attendant

The Housekeeping Room Attendant is responsible for maintaining guest rooms and p...

Location

United States , Austin

Salary:

18.00 USD / Hour

Prospera Hospitality

Expiration Date

Until further notice

Requirements

Prior housekeeping or hotel experience preferred, but not required
Ability to work independently and as part of a team
Strong attention to detail and commitment to cleanliness
Ability to stand, walk, bend, and lift up to 30 lbs. for extended periods
Flexible availability, including weekends and holidays
Ability to communicate effectively in English (Spanish a plus).

Job Responsibility

Clean and service assigned guest rooms, including making beds, changing linens, dusting, vacuuming, and sanitizing bathrooms
Replenish guest room supplies, amenities, and linens
Report maintenance issues, lost and found items, and safety concerns promptly
Follow all Hilton brand standards, safety guidelines, and cleaning procedures
Respond courteously to guest requests and communicate professionally with team members
Maintain cleanliness of hallways, service areas, and housekeeping carts
Adhere to attendance, uniform, and grooming standards.

What we offer

$18.00 per hour to start, with scheduled annual increases
Healthcare benefits are available, including medical, dental, and vision coverage
Short-term and long-term disability benefits also available
Paid time off is provided, including vacation, sick days, and holidays
Hilton employees may participate in the Go Hilton employee travel program.

Fulltime

New

Bartender

Join one of the UK's leading hospitality businesses as a bartender. In return yo...

Location

United Kingdom , Birmingham

Salary:

12.71 GBP / Hour

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Great people skills
Excellent organisational and multitasking abilities
Ability to keep a positive attitude in a fast-paced airport environment
Flexibility in hours, airport shifts can start at 3am
Also be able to provide a 5 year work/education/personal reference history and undertake a criminal record check
Due to alcohol licensing laws, applicants must be over 18 years of age

Job Responsibility

Create unforgettable guest experiences
Delivering warm welcomes
Staying fresh with drink recommendations
Preparing the perfect drinks
Maintaining the bar so we are always guest ready
Step in to support colleagues

What we offer

Free meal whenever you work
Up to 30% discount at all our brands and no limit on number of guests, incl. wagamama
Duty free discounts excluding alcohol and cigarettes
Access to a great discount platform, saving you money on everyday purchases and so much more
Wagestream platform to access your wages as they are earned
Superb training and development, apprenticeships open to all

Fulltime

New

Guest Arrival Expert

First impressions are everything. When guests arrive at our hotels, we want that...

Location

Germany , Sindelfingen

Salary:

Not provided

Marriott Bonvoy

Expiration Date

Until further notice

Requirements

High school diploma or G.E.D. equivalent
No related work experience
No supervisory experience
License or Certification: None

Job Responsibility

Process operational needs
Address guest requests
Complete reports
Share the highlights of the local area
Make transactions feel like part of the experience
Create a safe workplace
Follow company policies and procedures
Maintain confidentiality
Protect company assets
Uphold quality standards

Fulltime

Select Country

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 20, 2025

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