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

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

Pharmacy Technician

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

Location

United States , Drexel Hill

Salary:

Not provided

CVS Health

Expiration Date

June 22, 2026

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
Regular and predictable attendance, including nights and weekends
Ability to complete required training within designated timeframe
Attention and Focus
Customer Service and Team Orientation
Communication Skills
Mathematical Reasoning

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
Completing basic inventory activities, as permitted by law, and as directed by the pharmacy leadership team
Contributing to a high-performing team, embracing a growth mindset, and being receptive to feedback
Remaining flexible for both scheduling and business needs, while contributing to a safe, inclusive, and engaging team dynamic
Understanding and complying with all relevant federal, state, and local laws, regulations, professional standards, and ethical principles
Delivering additional patient health care services (e.g., immunizations, point-of-care testing, and voluntarily staffing offsite clinics), where allowable by law and supported by required training and certification
Where permissible, the Pharmacy Technician may also support immunizations, which includes the following responsibilities: Completing additional licensure and training requirements, in compliance with state Board of Pharmacy regulations, to obtain Technician Immunizer status to support preparing and administering vaccines
Educating patients about the importance of vaccines and referring patients to the Pharmacist-on-duty for vaccination questions

What we offer

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
and other resources, based on eligibility

Fulltime

New

Mri Technologist

MedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is see...

Location

United States , Springfield

Salary:

Not provided

MedPro Healthcare Staffing

Expiration Date

Until further notice

Requirements

Completion of a two year approved School of Radiologic Technology
Valid state radiology registration as required by state law
Registry by the American Registry of Radiologic Technology.

Job Responsibility

MRI technologists utilize their knowledge of anatomy, physiology and the principles of MRI to safely and efficiently operate MRI scanners, assisting in the diagnosis of disease and injury.
Ensure the safety of patients, staff and visitors who come in contact with the powerful magnetic field of a MRI scanner.
Position patients and coils on a table that slides inside the MRI scanner.
Inject contrast media as required.
Set appropriate technical parameters, operate MRI scanners and related equipment, and observe image data on computer monitors during scans.
Be familiar with the differences from a normal image and an abnormal image.
Recognize and respond to life threatening situations.
Assure compliance with federal, state, and local technical and professional regulations and accepted practiced guidelines.
Delivers quality, cost effective patient care in a professional manner.
Works effectively to maintain an environment of excellence, which is patient focused, providing timely, compassionate, quality patient care.

What we offer

Weekly pay and direct deposit
Full coverage of all credentialing fees
Private housing or housing allowance
Group Health insurance for you and your family
Company-paid life and disability insurance
Travel reimbursement
401(k) matching
Unlimited Referral Bonuses up to $1,000

Fulltime

New

Pharmacy Technician

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

Location

United States , Oakville

Salary:

18.94 - 28.94 USD / Hour

CVS Health

Expiration Date

June 23, 2026

Requirements

Must be at least 16 years of age
Licensure requirements vary by state
Attention and Focus
Customer Service Orientation
Communication Skills
Mathematical Reasoning
Problem Resolution
Physical Demands
Visual Acuity
High School diploma or equivalent preferred but not required.

Job Responsibility

manage all assigned pharmacy workstations and tasks to support the team's ability to promptly, safely and accurately fill patient prescriptions
provide caring service that exceeds customer expectations

What we offer

dental
vision
wellness resources
employee discounts
access to certain voluntary benefits

Parttime

New

Cath Lab Registered Nurse

MedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is see...

Location

United States , Denville

Salary:

Not provided

MedPro Healthcare Staffing

Expiration Date

Until further notice

Requirements

Active RN License
Degree from accredited nursing program
BLS & ACLS Certifications
Eighteen months of recent experience in an Acute Care Cath Lab setting

Job Responsibility

The Cardiac Cath Lab RN performs angioplasties, implants pacemakers and diagnoses cardiac conditions with an invasive catheterization procedure
Administer care for heart disease and heart attack patients by obtaining visual diagnostics of the arteries of the heart
Identify blockages, assisting the physician during procedures, and monitoring the patient’s status at other times
Administer interventional procedures like cardiac catheterizations, angioplasties, pacemaker and/or defibrillator implantation, and related interventional or diagnostic procedures

What we offer

Weekly pay and direct deposit
Full coverage of all credentialing fees
Private housing or housing allowance
Group Health insurance for you and your family
Company-paid life and disability insurance
Travel reimbursement
401(k) matching
Unlimited Referral Bonuses up to $1,000

New

Pharmacy Technician

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

Location

United States , Tipp City

Salary:

17.00 USD / Hour

CVS Health

Expiration Date

July 25, 2026

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
Regular and predictable attendance, including nights and weekends
Ability to complete required training within designated timeframe
Attention and Focus: Ability to concentrate on a task over a period of time
Ability to pivot quickly from one task to another to meet patient and business needs
Ability to confirm prescription information and label accuracy, ensuring patient safety
Customer Service and Team Orientation: Actively look for ways to help people, and do so in a friendly manner

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

Parttime

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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