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

Data Center Junior Field Engineer

The Data Center Junior Field Engineer (Apprenticeship) supports operational team...

Location

France , Marcoussis

Salary:

Not provided

DATA4 Group

Expiration Date

Until further notice

Requirements

Student enrolled in an apprenticeship program (Bachelor to Master level) in: Electrical Engineering
HVAC / Mechanical Engineering
Industrial Maintenance
Automation / Electrotechnics
Energy Engineering
Basic knowledge of industrial electrical and/or mechanical systems
Strong interest in automation, controls, and supervision systems
Ability to read basic technical drawings and schematics
Good command of standard IT tools (Excel, Office)
Strong curiosity and attention to detail

Job Responsibility

Support Facility Managers (FM) and Critical Environment Managers (CEM) in the monitoring of electrical, mechanical, and BMS systems
Participate in site inspections and technical walkdowns
Assist in basic analysis of BMS alarms and events
Support first-level incident response and troubleshooting activities, under supervision
Learn and understand data center electrical architectures (SLD, redundancy, backup systems)
Learn and understand cooling and HVAC systems (chillers, CRAH units, cooling plants, free cooling)
Learn and understand BMS and control systems (sensors, automation logic, alarms)
Participate in functional tests, periodic inspections, and supervised maintenance activities
Support the update and structuring of technical documentation: Single Line Diagrams (SLD), Operating procedures (SOP / EOP), Equipment inventories, CMMS data and records
Contribute to documentation consistency and standardization across sites

Fulltime

New

Administrative Assistant

We are seeking an organized and proactive Administrative Assistant for a part-ti...

Location

Greece , Athens

Salary:

Not provided

Randstad

Expiration Date

Until further notice

Requirements

Proven experience in administrative or secretarial roles with an ability to prioritize effectively
A university/bachelor degree
Strong written communication skills in English
Proficiency in Microsoft Office Suite (Word, Excel, Outlook)

Job Responsibility

Manage daily operations, organize digital and physical archives, and handle incoming/outgoing correspondence
Serve as the primary point of contact for organization members, handling inquiries and managing registration or renewal processes
Coordinate Board of Directors meetings, record minutes, and follow up on the implementation of key decisions
Provide secretarial support for the organization of conferences, workshops, and educational events within the energy sector
Track membership fees, issue invoices in collaboration with the accounting department, and manage office operational expenses
Maintain the membership database and assist in distributing newsletters regarding the latest developments in the green energy industry

Parttime

New

Senior Administrative Assistant

Robert Half is seeking an experienced and highly organized Senior Administrative...

Location

United States , Bethlehem

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
associate’s or bachelor’s degree preferred
3+ years of administrative support experience, preferably in a senior-level role
Strong proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint and Outlook
Excellent written and verbal communication skills
Strong organizational, time management and multitasking abilities
Ability to work independently, prioritize tasks and meet deadlines
Professional demeanor and strong attention to detail.

Job Responsibility

Provide high-level administrative support to managers, departments or senior leadership
Manage complex calendars, schedule meetings and coordinate appointments
Prepare correspondence, reports, presentations and other business documents
Coordinate travel arrangements, expense reports and meeting logistics
Serve as a point of contact for internal and external communications
Maintain organized records, files and documentation
Assist with project coordination, follow-up on action items and process improvements
Support office operations and help ensure administrative processes run efficiently
Handle sensitive and confidential information with discretion.

What we offer

Medical, vision, dental, and life and disability insurance
401(k) plan
Free online training.

New

Controller

Our client, a fast‑growing, capital‑intensive business in the infrastructure spa...

Location

United States , Coconut Creek

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in a Controller role within construction, real estate development, or a closely related project-based industry
Strong understanding of guaranteed maximum price contracts and the financial practices associated with commercial development projects
Demonstrated ability to manage pay applications, project cost reporting, and financial oversight for active construction work
Proficiency in document control, document scanning, and maintaining accurate supporting records for accounting and project files
Solid knowledge of financial reporting, budgeting, reconciliation, and internal control procedures
Strong organizational skills with the ability to compile, review, and manage high volumes of detailed documentation
Effective communication skills and the ability to work closely with project stakeholders, accounting teams, and leadership
CPA with 7–10+ years of experience
Strong systems experience (including QuickBooks/ERP) required

Job Responsibility

Direct financial management activities for construction and commercial development projects, ensuring accurate oversight of budgets, costs, and reporting. AIA Reporting, pay applications
Prepare and review project-related financial statements and management reports to support business decisions and operational visibility
Oversee accounting processes tied to guaranteed maximum price contracts, including cost tracking, variance analysis, and compliance monitoring
Manage the preparation, review, and processing of pay applications to help maintain accurate billing and cash flow performance
Establish and maintain organized document control practices for financial and project records, including scanned files and supporting documentation
Coordinate the compilation of project documents and financial materials required for audits, reviews, and internal reporting needs
Partner with project and operational teams to monitor contract performance, identify financial risks, and improve reporting consistency
Support process improvements related to recordkeeping, document management, and financial controls within the construction accounting function

What we offer

medical, vision, dental, and life and disability insurance
401(k) plan

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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