Supervisor Appeals – Medicare

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Oversee the Medicare Fee-for-Service appeals unit for Part A and/or Part B.

• Assign tasks to appeal representatives and technical personnel.

• Manage resources and inventory to adhere to CMS thresholds and internal standards.

• Assist in the preparation of budgets and monitor performance against financial plans.

• Ensure adherence to CMS requirements, management controls, process quality plans, change requests, and both internal and external audits.

• Provide direct oversight and/or technical guidance to non-clinical processing staff responsible for pay-or-deny decisions.

• Interact with CMS, the Office of Inspector General, appellants, authorized representatives, providers, beneficiaries, contractors, vendors, management, and internal departments.

• Document departmental protocols and controls effectively.

• Identify opportunities for enhancing the performance of Medicare Services by utilizing Medicare policies, claims-processing procedures, and data-processing systems.

• Assist in the development of guidelines and procedures in accordance with CMS directives.

• Recruit staff, conduct performance evaluations, monitor staff performance, provide feedback, and implement corrective measures.

• Organize provider education initiatives.

• Handle personnel-related responsibilities ensuring standards for production, quality, training, coaching, and mentoring are met.

• Manage challenging situations involving high-profile or dissatisfied providers.

• Investigate and analyze issues related to Medicare claims processing and departmental operations.

• Suggest and apply process enhancements to improve efficiency, reduce costs, boost productivity, and enhance quality.

• Assist or lead priority projects while supporting the unit's Manager.

• Supervise a team of 30 direct reports.

• Travel is not required for this position.

⛳️ Requirements

• High School diploma or GED is required.

• 1-3 years of experience in a leadership or supervisory role is necessary.

• 1-3 years of experience in the Medicare Program or familiarity with Medicare regulations is required.

• 3-5 years of experience in a personal computer environment, particularly with Microsoft Windows or a similar system.

• Experience with claims processing systems (e.g., MCS/FISS) is essential.

• Strong verbal and written communication abilities are required.

• Capability to manage multiple tasks under pressure.

• Must fulfill all CMS and Organizational Medicare Services security requirements.

• Must adhere to relevant laws, regulations, company policies, HIPAA, privacy policies, information security policies, and the Code of Business Conduct.

• A Bachelor’s degree along with 3 years of experience in the healthcare sector is preferred.

• An Associate's degree coupled with 5 years of experience in the healthcare field is also preferred.

• Experience in the Medicare Program or with Medicare regulations is favored.

• Appeals experience is advantageous.

🏝️ Benefits

• Comprehensive health insurance.

• Retirement plan options.

• Paid time off and holidays.

• Professional development opportunities.

• Supportive work environment.