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

Production Technician Fill, I

This is where your work makes a difference. At Baxter, we believe every person—r...

Location

United States , Marion

Salary:

44000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

High School Diploma, GED or equivalent
Must be at least 18 years of age
Must have basic English written and oral communication skills adequate to communicate with other team members
Understand verbal and written safety and quality instructions and read and comprehend written work instructions including words and drawings
Must be able to perform basic mathematics
Proficient in how to use a calculator and measurement tools as well as basic hand tools
Must have basic computer skills

Job Responsibility

Operate, monitor and make minor adjustments as necessary to manual and automated filling equipment and machines using controls on a (HMI) or by way of manual adjustments (ex. Photo-eye and sensors)
Perform scheduled quality checks, disposition product, identify any deviations that may occur and take the appropriate action to include stopping production on the machine if necessary
Document required information on manufacturing logs and/or POMS system
Set-up load and replenish production supplies by use of a powered industrial truck (PIT) at a rate consistent with production needs
Execute Batch/Code changes, tank changes, as well as sub lots as required
Escalate any inefficiency in the machine’s performance including mechanical wear, alignment, adjustment, and setup issues
Notify the supervisor and take appropriate action if any safety, quality, mechanical or discrepancy issues occur
Use tools to measure the product, ensuring the output meets specifications, making adjustments/repairs as needed
Perform and document scheduled cleaning activities
Learn, understand and apply rigorous quality standards, Standard Operating Procedures (SOPs) and Current Good Manufacturing Practices (cGMP)

What we offer

Shift flexibility to trade shifts and leverage overtime opportunities
Medical, Dental and Vision coverage
160 hours of Paid Time Off and Paid Holidays
401K match
Employee Stock Purchase Program
Paid Parental Leave
Tuition Reimbursement

Fulltime

New

Production Technician I, Fill

Location

United States , Marion

Salary:

44000.00 USD / Year

Baxter

Expiration Date

Until further notice

Requirements

High School Diploma, GED or equivalent
Must be at least 18 years of age
Must have basic English written and oral communication skills adequate to communicate with other team members
Understand verbal and written safety and quality instructions and read and comprehend written work instructions including words and drawings
Must be able to perform basic mathematics
Proficient in how to use a calculator and measurement tools as well as basic hand tools
Must have basic computer skills

Job Responsibility

Operate, monitor and make minor adjustments as necessary to manual and automated filling equipment and machines using controls on a (HMI) or by way of manual adjustments (ex. Photo-eye and sensors)
Perform scheduled quality checks, disposition product, identify any deviations that may occur and take the appropriate action to include stopping production on the machine if necessary
Document required information on manufacturing logs and/or POMS system
Set-up load and replenish production supplies by use of a powered industrial truck (PIT) at a rate consistent with production needs
Execute Batch/Code changes, tank changes, as well as sub lots as required
Escalate any inefficiency in the machine’s performance including mechanical wear, alignment, adjustment, and setup issues
Notify the supervisor and take appropriate action if any safety, quality, mechanical or discrepancy issues occur
Use tools to measure the product, ensuring the output meets specifications, making adjustments/repairs as needed
Perform and document scheduled cleaning activities
Learn, understand and apply rigorous quality standards, Standard Operating Procedures (SOPs) and Current Good Manufacturing Practices (cGMP)

What we offer

Shift flexibility to trade shifts and leverage overtime opportunities
Medical, Dental and Vision coverage
160 hours of Paid Time Off and Paid Holidays
401K match
Employee Stock Purchase Program
Paid Parental Leave
Tuition Reimbursement
insurance coverage for basic life, accident, short-term and long-term disability, and business travel accident insurance
Flexible Spending Accounts
educational assistance programs

Fulltime

New

Hr & Payroll Advisor

NXTGEN are supporting an established Norfolk-based organisation in the search fo...

Location

United Kingdom , Norwich

Salary:

14.00 - 18.00 GBP / Hour

NXTGEN Recruitment

Expiration Date

Until further notice

Requirements

End-to-end payroll processing
Starters, leavers and contractual changes
Payroll systems and HR databases
Tax, NI, pensions and statutory payments
HR administration within a fast-paced environment
Producing reports, letters and employee documentation
Supporting wider HR and recruitment activity
Strong attention to detail
Excellent organisational skills
Ability to manage confidential information professionally

Job Responsibility

Managing payroll processes from start to finish
Supporting starters and leavers
Processing contractual changes
Handling maternity and sickness queries
Maintaining HR/payroll systems
Supporting the wider HR function where required

New

Sous Chef

As Sous Chef, your key responsibilities include preparing, cooking, and presenti...

Location

United Kingdom , Bournemouth

Salary:

32000.00 GBP / Year

Aimbridge Hospitality EMEA

Expiration Date

June 20, 2026

Requirements

great cooking skills and a deep understanding of different ingredients, flavors, and cooking techniques
cool head and ability to work well under pressure
ability to delegate tasks appropriately
strong organisational skills
commitment to maintaining a clean and hygienic kitchen environment
understanding of profit margins

Job Responsibility

preparing, cooking, and presenting dishes
managing and training chefs
helping to develop new dishes and menus
ensuring high standards of food hygiene and health and safety regulations
monitoring portion and waste control to maintain profit margins

What we offer

industry leading training and leadership development opportunities
hotel discounts portfolio wide – staff rates and up to 50% discount on food & beverage and spa
access to Stream - stream up to 40% pay as it is earned and set automatic savings
24/7 access to our employee assistance programme
career and lifestyle breaks
uncapped incentives
flexible working opportunities
minimum of 30 days holiday
staff meals on duty
paid breaks

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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