Supervisor Appeals – Medicare

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🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $62.7k - $97.2k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Highmark Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1852

🛡️ Insurance

💼 Consulting

📦 Logistics

💰 $5M Grant on 2021-05

Insurance • Consulting • Logistics

Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike.

📋 Description

• Supervise the Part A and/or Part B Medicare Fee-for-Service appeals unit • Delegate assignments to appeal representatives and technical staff • Manage resources and inventories to meet CMS thresholds and internal customer standards • Assist with budget preparation and monitor performance against budget • Ensure compliance with CMS requirements, management controls, process quality plans, change requests, and internal and external audits • Provide direct oversight and/or technical direction to non-clinical processing staff making pay-or-deny determinations • Communicate with CMS, the Office of Inspector General, appellants, authorized representatives, providers, beneficiaries, contractors, vendors, management, and internal departments • Document department protocols and controls • Identify opportunities to improve Medicare Services performance using Medicare policies, claims-processing procedures, and data-processing systems • Assist in guideline and procedure development according to CMS instructions • Hire staff, conduct performance appraisals, monitor performance, provide feedback, and take corrective action • Coordinate provider education activities • Maintain personnel-related responsibilities and ensure production, quality, training, coaching, and mentoring standards • Manage high-profile or irate provider situations • Investigate and analyze Medicare claims-processing and departmental problems • Recommend and implement process improvements for efficiency, cost reduction, productivity, and quality gains • Assist or direct priority projects and support the Manager of the unit • Supervise 30 direct reports • No travel required

🎯 Requirements

• High School diploma or GED • 1-3 years of experience in a leadership/supervisory position • 1-3 years of experience working in Medicare Program or with Medicare regulations • 3-5 years of experience working on a personal computer in Microsoft Windows or similar environment • Experience using claims process system (e.g. MCS/FISS) • Strong verbal and written communication skills • Ability to multitask under pressure • Must meet all CMS and Organizational Medicare Services security requirements • Must comply with applicable laws, regulations, company policies, HIPAA, privacy policies, information security policies, and Code of Business Conduct • Bachelor’s degree and 3 years of experience in a healthcare industry preferred • Associates degree and 5 years of experience in a healthcare industry preferred • Medicare Program or Medicare regulations experience preferred • Appeals experience preferred