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

Assistant Manager

We want you to join our team as an Assistant Manager. If you have the desire to ...

Location

United States of America , Duluth

Salary:

15.00 - 19.00 USD / Hour

Circle K

Expiration Date

Until further notice

Requirements

Ability to lead a team of employees/management
Recruiting, interviewing, and hiring
Delegation and follow-up
Teaching and motivating others
Planning and organizing
Communicating your plans and ideas
Cash-handling and bookkeeping
Problem solving
Advocating and empathizing
Safety and Security

Job Responsibility

Assist the Store Manager with oversight of the Stationstore operations
Help with hiring, supervising and working with the staff to accomplish daily tasks, bookkeeping and merchandising
Help to maintain high standards and provide fast and friendly service to customers
Execute the food program

What we offer

Medical, Vision, Dental, & Life Insurance/Short & Long Term Disability
Flexible Schedules
Weekly Pay
Paid Vacations
Large, Stable Employer
Fast Career Opportunities
Work With Fun, Motivated People
Task Variety
Paid Comprehensive Training
401K With a Competitive Company Match

Fulltime

New

Accounts Payable Clerk

We are looking for an Accounts Payable Clerk to join a finance team in Laurel, M...

Location

United States , Laurel

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in accounts payable with hands-on responsibility for invoice processing and payment support
Ability to handle credit card reconciliations accurately in a high-volume environment
Proficiency in coding invoices and assisting with check run activities
Working knowledge of Microsoft Excel for tracking, review, and reconciliation tasks
Familiarity with accounting platforms such as Microsoft Dynamics and expense tools such as Concur
Strong organizational skills with the ability to manage deadlines and ensure timely payments
Availability to work onsite five days per week in Laurel, Maryland
Associate degree or higher in accounting, finance, or a related field is preferred

Job Responsibility

Process a large volume of vendor invoices with careful attention to coding, approvals, and payment deadlines
Reconcile corporate credit card activity and resolve discrepancies to maintain accurate financial records
Prepare and support check runs while helping ensure vendors are paid correctly and on time
Review invoice details for completeness and accuracy before entering transactions into the accounting system
Use tools such as Microsoft Dynamics, Concur, and Excel to manage payable records and track outstanding items
Communicate with internal departments and vendors to clarify billing issues, correct errors, and follow up on pending approvals
Maintain organized documentation for payments, reconciliations, and supporting records in line with accounting procedures
Collaborate with the accounts payable team and finance leadership to keep daily workload moving efficiently and meet urgent processing needs

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan

Fulltime

New

Pharmacy Technician

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

Location

United States , Dracut

Salary:

17.00 - 27.00 USD / Hour

CVS Health

Expiration Date

Until further notice

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
State-level licensure and national certification requirements vary by state, click here to learn more.

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

dental
vision
wellness resources
employee discounts
access to certain voluntary benefits
other programs

Parttime

New

Customer Service Representative

We want you to join our team as a Customer Service Representative. If you have t...

Location

United States of America , Anoka

Salary:

15.00 - 16.50 USD / Hour

Circle K

Expiration Date

Until further notice

Requirements

Selling products to customers
Providing excellent customer care
Communication and friendly conversation
Performing at a quick pace while having fun
Working as part of a team to accomplish daily goals
Coming up with great ideas to solve problems
Thinking quickly and offering suggestions

Job Responsibility

Greet customers
run the register
cashier
make purchase suggestions
sometimes work with our food program
work around the store (inside and out) in many different areas to help maintain high standards for store appearance
provide fast and friendly service to customers
provide regular and predicable onsite attendance
interact with many customers daily
working with a fun, energetic team accomplishing daily tasks around the store

What we offer

Medical, Vision, Dental, & Life Insurance/Short & Long Term Disability
Flexible Schedules
Weekly Pay
Weekly Bonus Potential
Large, Stable Employer
Fast Career Opportunities
Work With Fun, Motivated People
Task Variety
Paid Comprehensive Training
401K With a Competitive Company Match

Parttime

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

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Medicare Audit & Appeals Supervisor