Medicare Audit & Appeals Supervisor, Baxter

Medicare Audit & Appeals Supervisor

Baxter

Location:

United States, Saint Paul

Category:

-

Contract Type:

Employment contract

Salary:

5666.67 - 7791.67 USD / Month ▼

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Job Description:

Supervise employees in the Revenue Cycle Management function while acting as a resource for problem-solving individual accounts issues; Responsible for Medicare audits and appeals and managing team performance.

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
Prepare and submit persuasive appeal request to Medicare
Collaborate with supervisory team to ensure consistency in communications and procedures across Payer, Customer, Operations, Revenue Cycle Management
Identify and develop new processes and streamline existing workflows
Maintain daily, positive communication with other departments
Answer questions and aid new and existing team members
Coordinate problematic accounts with management
Coordinate teamwork and ensure quality objectives and work deadlines are being met
Act as a liaison to other departments related to payer or patient-specific issues
Maintain understanding of department policies and procedures.

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
Proficiency in Microsoft Office Software
Exceptional written, verbal, interpersonal communications and presentation skills
Detail orientation
Ability to work independently, multi-task and manage workload
Experience with TIMS and Waystar/ E-Solutions Clearinghouse preferred.

Nice to have:

Six Sigma Green Belt
Experience with TIMS and Waystar/E-Solutions Clearinghouse
Experience with Durable Medical Equipment provider
Knowledge of Medicare Regulations
Knowledge of the various contractors Medicare Fee for Service audits.

What we offer:

Medical and dental coverage starting on day one
Basic life insurance
Accident insurance
Short-term and long-term disability insurance
Business travel accident insurance
Employee Stock Purchase Plan (ESPP)
401(k) Retirement Savings Plan with 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 leave
Paid parental leave
Commuting benefits
Employee Discount Program
Employee Assistance Program
Childcare benefits.

Additional Information:

Job Posted:

March 20, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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