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Medicare Audit & Appeals Supervisor

https://www.baxter.com/ Logo

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:

5666.67 - 7791.67 USD / Month

Job Description:

Supervise employees in the Revenue Cycle Management function while acting as a resource for problem-solving individual accounts issues; Responsible for Medicare audits and appeals and managing team performance.

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
  • 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.

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:

  • Six Sigma Green Belt
  • Experience with TIMS and Waystar/E-Solutions Clearinghouse
  • Experience with Durable Medical Equipment provider
  • Knowledge of Medicare Regulations
  • Knowledge of the various contractors Medicare Fee for Service audits.
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
  • Paid time off ranging from 20 to 35 days based on length of service
  • Family and medical leave
  • Paid parental leave
  • Commuting benefits
  • Employee Discount Program
  • Employee Assistance Program
  • Childcare benefits.

Additional Information:

Job Posted:
March 20, 2025

Employment Type:
Fulltime
Work Type:
On-site work
Job Link Share:

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