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

Sen teaching assistant

As a long-term SEN TA, you will be a vital part of a multidisciplinary team. You...

Location

United Kingdom , Reigate

Salary:

90.00 - 95.00 GBP / Day

Randstad

Expiration Date

June 04, 2026

Requirements

Resilience & Compassion
Experience: Previous experience with complex needs, epilepsy, or ASD is highly desirable
Commitment: As this is a long-term contract, we are looking for someone who wants to build lasting relationships with our young people
Communication: Strong verbal and non-verbal communication skills (experience with Makaton or PECS is a bonus)

Job Responsibility

Specialised Support: Assisting students with complex needs, ensuring their safety and engagement in learning activities
Medical Awareness: Maintaining a calm and vigilant approach to supporting students with epilepsy and other neurological conditions
Personalised Care: Implementing tailored strategies for autism and learning difficulties as outlined in EHCPs
Transition Support: Helping students navigate the move between classroom learning and their residential environment

What we offer

Professional Growth: Gain invaluable experience in a specialised field involving complex neurological conditions
Long-term Stability: A consistent role within a supportive and highly skilled team
training and education
Referral Bonus

Fulltime

New

Primary Teaching Assistant

Do you have a passion for education and a desire to make a difference in young l...

Location

United Kingdom , Reigate

Salary:

85.00 GBP / Day

Randstad

Expiration Date

June 05, 2026

Requirements

A genuine passion for supporting student's educational growth and development
Excellent communication skills and the ability to build positive relationships with students and staff
Previous experience in an educational setting or relevant qualifications is advantageous
Flexibility, adaptability, and a proactive approach to assisting in classroom activities
Compliance with DBS checks and eligibility to work in the UK

Job Responsibility

Work collaboratively with the class teacher, providing invaluable support in various classroom activities
Offering one-on-one guidance to small group sessions
Assist in creating an engaging and inclusive learning environment where every student can thrive

What we offer

Versatile Engagement: Engage with diverse learners and contribute to their academic journey
Competitive Compensation: Enjoy competitive pay rates and flexible working arrangements
Professional Development: Access training and growth opportunities to enhance your skills
Supportive Environment: Collaborate with a dedicated team committed to student success
Rewarding Experience: Make a tangible difference in shaping young minds and futures
Refer a friend bonus scheme

New

SEN Teacher

Temporary SEN Teacher | Specialist SEN School Location: West Sussex Daily Rate: ...

Location

United Kingdom , Reigate

Salary:

130.00 - 160.00 GBP / Day

Randstad

Expiration Date

June 04, 2026

Requirements

QTS (Qualified Teacher Status) Essential
Demonstrable experience in teaching pupils with SEN
Ability to commit to the full duration of the temporary contract once confirmed
Highly skilled at tailoring the curriculum to meet diverse learning styles and individual Education, Health and Care Plans (EHCPs)
Resilient, reliable, and proactive in managing a specialist classroom with confidence

Job Responsibility

Planning and delivering high-quality, differentiated lessons tailored to the specific learning and developmental needs of a small class group
Taking full responsibility for your class, ensuring all pupils are engaged, safe, and making progress during your tenure
Implementing effective sensory and behaviour management strategies to maintain a positive and engaging classroom environment
Working closely with and directing a dedicated team of Teaching Assistants to maximise individual pupil support
Ensuring accurate recording and reporting of pupil progress, achievements, and well-being

What we offer

Competitive Daily Rate: Paid weekly at a rate of £130 - £160 per day
Small Class Sizes
Supportive Culture
Professional Growth
training and education
Safeguarding & Prevent

New

Special Educational Needs (SEN) Teaching Assistant

Are you a champion for inclusive education? We are seeking a compassionate, skil...

Location

United Kingdom , Reigate

Salary:

90.00 - 95.00 GBP / Day

Randstad

Expiration Date

June 10, 2026

Requirements

Relevant Experience: Experience working with children or young people (ages 4-18), specifically those with complex SEN
Subject Knowledge: A deep understanding of learning difficulties, disabilities, and effective intervention strategies across various developmental stages
Adaptive Communication: The ability to tailor your style to the specific needs of individual students, whether they are in Reception or Sixth Form
Resilience: Exceptional patience and the ability to remain calm and proactive during challenging situations
Commitment: A genuine passion for safeguarding and promoting the welfare of every pupil

Job Responsibility

Implementing IEPs & EHCPs: Deliver targeted support programs by adapting resources and teaching strategies to meet the specific needs outlined in students' plans
Specialist Interventions: Provide high-quality 1:1 or small-group support for students with ASD, MLD, Speech and Language needs, and SEMH challenges
Age-Appropriate Support: Adapt your approach to support children developing foundational skills in Primary, through to young adults preparing for life after school
Proactive Behaviour Management: Utilise positive strategies to manage and de-escalate challenging behaviours, maintaining a safe and nurturing environment
Collaboration: Monitor progress and provide detailed feedback to teachers, the SENCo, and external agencies like Educational Psychologists
Pastoral Care: Support emotional well-being and assist with personal care or mobility where required (full training provided)

What we offer

Professional Growth: Access to excellent development opportunities and specialist SEN training
Team Culture: Work within a dedicated, multi-disciplinary Inclusion team
Stability: A long-term contract in a highly rewarding environment
Referral Bonus

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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