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

Healthcare Assistant & Lead Healthcare Assistant

Are you passionate about supporting older people and making a meaningful differe...

Location

Ireland , Cork

Salary:

Not provided

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Experience in elderly care is desirable but not essential (training may be provided)
QQI Level 5 in Healthcare Support or equivalent is an advantage
A caring, patient and respectful approach to supporting older people
Ability to work flexible shifts including days, nights, and weekends
Strong commitment to resident safety, dignity and wellbeing
Applicants must have legal entitlement to work in Ireland

Job Responsibility

Deliver person-centred care to residents with dignity and respect
Support residents with activities of daily living where required
Encourage independence and social engagement
Maintain a clean, safe and comfortable living environment
Build positive relationships with residents, families, and colleagues
Follow all health, safety and safeguarding procedures
Assist with compliance processes, inspections, and quality standards
Lead Healthcare Assistants will also assist in guiding care teams, supporting best practice, and helping maintain high standards of care delivery

What we offer

Flexible working hours to support work–life balance
Local employment opportunities within the Douglas, Cork area
Competitive rates of pay in line with experience and role
Supportive team environment with ongoing training and development
Employee wellbeing initiatives
Uniform provided
Free on-site parking
Meals provided while on duty

New

Bakery Team Member

Join us to "Change Hospitality For Good". Here at the Cornish Bakery, we want to...

Location

United Kingdom , Falmouth

Salary:

8.05 - 12.80 GBP / Hour

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Eligible to live and work in the UK

Job Responsibility

Make the World’s Best Coffee
Deliver Outstanding Customer Service
Prepare Award Winning Food
Maintain High standards within the Bakery
Be part of a Team who strive to Aim Higher at all times

What we offer

50% discount on food and drink
Pasty Perks – bespoke reward system offering discounts and savings on favourite brands
Financial well-being benefit through Stream – save directly from wages into a high interest savings account or access wages before pay-day
Employer funded health and wellbeing services with access to a 24/7 GP line, Employee Assistance Program and discounted gym memberships
Paid birthday day off
Member of the shareholder fund (service dependent)
Team social events with in-bakery incentives
Up to 28 days of holiday (including bank holidays), pro rata if necessary

New

Housekeeping Assistant

In Glasgow's prestigious West End, Kelvinside Manor provides luxurious accommoda...

Location

United Kingdom , Glasgow

Salary:

12.27 GBP / Hour

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Experience from a housekeeping or domestic cleaning role
Basic understanding of infection control, COSHH, and compliance standards
Ability to follow instructions and cleaning schedules
Ability to report issues
Ability to work well with others in a professional and courteous manner
Pride in your work, attention to detail, time management, and respectful communication
Ability to work well as part of a team or on your own
Demonstrating a kind and caring nature to all within the care home
Satisfactory references
Disclosure Scotland Scheme Membership (PVG)

Job Responsibility

Maintaining the highest levels of cleanliness in public areas and bedrooms within the home
Responsible for the wash, dry, iron and put away of laundry
Ensuring that our residents' care home facilities, public areas and rooms are maintained to the highest cleaning standards
Replenish and maintain supplies in both resident rooms and common areas
Communicate effectively with residents and colleagues to address needs and concerns

What we offer

Competitive benefits
Overtime rates
Flexible working hours considered

Parttime

New

Product Manager - Observability AIOps

We are looking for a Product Manager - Observability AIOps to lead the strategy,...

Location

Salary:

Not provided

Coca-Cola HBC

Expiration Date

Until further notice

Requirements

Bachelor’s or Master’s in Computer Science, IT, or related field
5+ years in Observability and AIOps within hybrid, complex environments
Strong knowledge of FSO (APM, logs, traces, RUM), SLI/SLOs, and service topology
Hands on with Dynatrace or similar smart observability (i.e. Datadog, Splunk, New Relic) and AIOps engines (correlation, deduplication, anomaly detection, auto remediation)
Experience integrating with ServiceNow, SAP, CI/CD pipelines, cloud services (Azure, AWS, GCP), and automation platforms
Solid understanding of modern application architectures, networks, databases, and infrastructure
Excellent communication and stakeholder management skills
Fluent in English

Job Responsibility

Define and execute the product vision and roadmap for Observability and AIOps, aligned with company objectives
Develop capabilities across metrics, logs, traces, RUM/synthetics, topology, and AI driven insights (anomaly detection, forecasting, correlation)
Prioritize features that enhance reliability, reduce MTTR, automate L1/L2 tasks, and improve customer experience
Collaborate with engineering, platform teams, and partners to ensure effective instrumentation, intelligent alerting, and automated workflows
Integrate Observability with ServiceNow, CI/CD, cloud platforms, and business processes to streamline operations
Leverage analytics to detect issues proactively, reduce noise, and optimize performance and resource usage
Champion an observability first and automation driven culture across teams

What we offer

Coaching and mentoring programs
Development opportunities
Equal opportunity employer
IT Equipment
Work with iconic brands
Supportive team

New

Reactive Plumbing Engineer

Metro Plumb is a national plumbing business with more than 40 local depots acros...

Location

United Kingdom , Croydon

Salary:

33000.00 - 38000.00 GBP / Year

360 Resourcing Solutions

Expiration Date

Until further notice

Requirements

Proven experience as a Plumbing/ Plumbing & Heating Engineer for both domestic and commercial customers
NVQ Level 2
Full UK driving license
Flexibility to work overtime
DBS checked (or willingness for this to be carried out)

Job Responsibility

Carry out all aspects of plumbing work, including but not limited to, installation and maintenance of toilets, taps, ball valves, siphons, flexible hoses, pipework, radiator valves, cylinders, heating systems etc across a range of domestic and commercial customers
Attend primarily emergency plumbing jobs relating to installations/leaks/issues

What we offer

Personal development plan with timelines to achieve good OTE and growth
Auto enrolment into pension scheme
Company van and fuel card
Branded uniform
Company mobile
Personal development and genuine career opportunity
Induction and training
On-call rota in addition to salary
Optional overtime
Accommodating hours to support personal life

Fulltime

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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