Supervisor Appeals - Medicare (Remote) in PA or DE

About the role

This job supervises the Part A and/or Part B Medicare Fee-for-Service appeals unit within the Organization's Medicare Services. Delegates assignments to appeal representatives and technical staff. Manages resources to ensure CMS thresholds and internal customer standards are achieved, in all workloads, within the unit (re-determinations, telephone and written re-openings, effectuations, and Provider Monitoring).

Responsibilities

• Displays effective communication skills.
  • Verbal and written communication with Director and Senior Management, peers, departmental staff, and various Corporate support departments.
  • Verbal and written communication with external business partners including Program Safeguard Contractors (PSC), Recovery Audit Contractors (RAC), and Qualified Independent Contractors (QIC) and vendors.
  • Verbal and written communication with our customers including the Centers for Medicare and Medicaid Services (CMS), providers, and beneficiaries.
• Contribute to the achievement of the department performance standards specified in the Statement of Work, budget, CMS internet only manual, award fee, EIP or other program memoranda.
• Delegate work assignments to sustain department performance.
• Aid in budget preparation and monitoring.
• Maintain inventory levels and move resources, schedule cross training, etc… to effectively manage to CMS thresholds.
• Ensure compliance with management controls, process quality plans, change requests, internal and external audits, etc.
• Document department protocols and controls.
• Identify opportunities, through the use of Medicare policies and procedures, claims processing procedures and related data processing systems, to improve the Organization's Medicare Services overall performance.
• Aid in guideline and procedural development in accordance with CMS instructions.
• Utilize available technology to effectively monitor all departmental inventories.
• Provide direct oversight and/or technical direction as necessary of processing staff that make decisions to pay or deny services.
• Coordinate provider education activities.
• Maintain primary responsibility for all personnel related matters.
• Hire staff for the unit.
• Complete and conduct performance appraisals.
• Monitor individual performance and document according to HMS and Organization protocols.
• Provide frequent feedback to staff and taking corrective action when necessary.
• Sustain appropriate production and quality levels for all staff.
• Assure all staff provide a high level of quality service and professionalism.
• Ensure all appropriate refresher/remedial training as well as coaching/mentoring is conducted based on input from the Technical Assistants, Business Coordinators, and Monitoring and Inspection management feedback as appropriate.
• Provide feedback to management on the status of their section to ensure the section contributes toward the department meeting and exceeding all performance standards.
• Manage high profile or irate provider situations.
• Cookordinate responses with other operational units or business partners as necessary.
• Cookordinate activities and exchange of information with external business partners.
• Detect, investigate, research and analyze problems in the Medicare claims processing system and departmental procedures which contribute to the occurrence of appeal workload.
• Identify and analyze operating deficiencies and work with other Medicare personnel to develop the appropriate solutions.
• Recommend, coordinate and initiate improvements to the process to achieve efficiency, cost reduction, productivity, and quality gains.
• Aid or direct projects for achieving specified goals related to assignments and responsibilities of priority defined by the Organization's Medicare Services management.
• Provide support and recommendations to the Manager of the unit and may be designated to participate in decision-making, impacting the efficiency and performance of the overall operation of the department.
• Other duties as assigned or requested.

Qualifications

• Minimum High School diploma or GED.
• 1-3 years of experience in a leadership/supervisory position.
• PREFERRED: Medicare Program or Medicare regulations experience.
• PREFERRED: Appeals experience.
• PREFERRED: Experience using claims process system (e.g. MCS/FISS).
• Bachelor’s degree and 3 years of experience in a healthcare industry.
• Associates degree and 5 years of experience in a healthcare industry.

Skills

• 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).

Benefits

Not specified.

Pay

Minimum $62,700.00 Pay Range Maximum $97,200.00 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.

Schedule

Not specified.