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

Ks2 Teacher

KS2 Teacher | Birmingham Salary: £140-233 per day Location: Central Birmingham...

Location

United Kingdom , Walsall

Salary:

140.00 - 233.00 GBP / Day

Randstad

Expiration Date

June 11, 2026

Requirements

Hold a valid UK QTS Teaching qualification
Have a minimum of 1 year's experience teaching in a UK secondary school setting
Have a passion for education and a genuine desire to make a difference in the lives of children around the Birmingham area

Job Responsibility

Cover a range of teaching responsibilities
delivering engaging lessons
providing differentiated support
managing classroom behaviour
Be a confident and adaptable educator who can quickly grasp new information and integrate seamlessly into different school environments
Maintain a strong commitment to safeguarding and promoting the welfare of children

What we offer

Flexible working - you set your own availability
Immediate supply bookings
Competitive rates of pay
A dedicated and supportive Education team
Established relationships with the schools you want to teach in
PAYE
Referral Bonus
training and education
Safeguarding & Prevent

New

Children's Social Worker - Children In Care

We are seeking a compassionate and skilled Children in Care Social Worker to joi...

Location

United Kingdom , Birmingham

Salary:

Not provided

Randstad

Expiration Date

June 10, 2026

Requirements

Qualified Social Worker with a degree in Social Work
Registration with Social Work England (SWE)
Experience working with children in care or in a similar role
Strong assessment, planning, and intervention skills
Excellent communication and relationship-building skills
Ability to work collaboratively within a team and with external partners
Commitment to safeguarding and promoting the welfare of children

Job Responsibility

Managing a caseload of children in care, ensuring each child receives individualized and effective support
Conducting comprehensive assessments and developing care plans
Monitoring and reviewing care plans to ensure they meet the needs of the child
Working closely with foster carers, residential staff, and other professionals to support the child's placement
Ensuring compliance with statutory regulations and safeguarding procedures
Preparing reports for court and attending court proceedings when necessary
Maintaining accurate records and documentation

What we offer

Competitive rate of £30.57 per hour
Supportive and collaborative working environment
Opportunities for professional development and ongoing training
Flexible working arrangements

Fulltime

New

Ks2 Teacher

Are you a passionate KS2 Teacher looking for teaching work that flexes with your...

Location

United Kingdom , Birmingham

Salary:

140.00 - 233.00 GBP / Day

Randstad

Expiration Date

June 11, 2026

Requirements

Hold a valid UK QTS Teaching qualification
Have a minimum of 1 year's experience teaching in a UK secondary school setting
Have a passion for education and a genuine desire to make a difference in the lives of children around the Birmingham area

Job Responsibility

Cover a range of teaching responsibilities
delivering engaging lessons
providing differentiated support
and managing classroom behaviour
Be a confident and adaptable educator who can quickly grasp new information and integrate seamlessly into different school environments
Maintain a strong commitment to safeguarding and promoting the welfare of children

What we offer

Flexible working - you set your own availability
Immediate supply bookings
Competitive rates of pay
A dedicated and supportive Education team
Established relationships with the schools you want to teach in
PAYE
Referral Bonus

Fulltime

New

Ks2 Teacher

KS2 Teacher | Birmingham Salary: £140-233 per day Location: Central Birmingham...

Location

United Kingdom , Solihull

Salary:

140.00 - 233.00 GBP / Day

Randstad

Expiration Date

June 11, 2026

Requirements

Hold a valid UK QTS Teaching qualification
Have a minimum of 1 year's experience teaching in a UK secondary school setting
Have a passion for education and a genuine desire to make a difference in the lives of children around the Birmingham area

Job Responsibility

Cover a range of teaching responsibilities
delivering engaging lessons, providing differentiated support, and managing classroom behaviour
Be a confident and adaptable educator who can quickly grasp new information and integrate seamlessly into different school environments
Maintain a strong commitment to safeguarding and promoting the welfare of children

What we offer

Flexible working - you set your own availability
Immediate supply bookings
Competitive rates of pay
A dedicated and supportive Education team
Established relationships with the schools you want to teach in
PAYE
Referral Bonus

Fulltime

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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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