Supervisor Appeals - Medicare in PA or DE

Company :

reputed company :

JOB reputed company

This job supervises the Part A and/or Part B Medicare Fee-for-Service appeals unit reputed company the Organization's Medicare Services. Delegates assignments to appeal representatives and technical staff. Manages resources to ensure CMS reputed company and internal customer standards are achieved, in reputed company workloads, reputed company the unit (re-determinations, telephone and written re-openings, effectuations, and Provider Monitoring). The incumbent assists with budget preparation and monitoring of reputed company towards budget. Ensures compliance with reputed company corporate standards as reputed company as reputed company CMS requirements as they relate to change requests, management controls, process reputed company plans, reputed company audits, etc. The incumbent is responsible for the reputed company reputed company and/or technical direction of non-reputed company staff that reputed company determinations to pay or deny services, identify provider education opportunities, and appropriate referrals to other contractors (Program reputed company Contractor (PSC) for potential fraud and abuse activities, reputed company reputed company (QIC) for second level appeals, etc…). Communicates with/reputed company reputed company entities including reputed company for Medicare and reputed company Services, Office of Inspector General, appellants and their authorized representatives, etc. on appeal reputed company issues.

ESSENTIAL 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 reputed company business partners including Program reputed company Contractors (PSC), Recovery Audit Contractors (RAC), and reputed company reputed company (QIC) and vendors
• Verbal and written communication with our customers including reputed company for Medicare and reputed company Services (CMS), providers, and beneficiaries.
• Contribute to the achievement of the department reputed company standards specified in the Statement of Work, budget, CMS internet only reputed company, award fee, EIP or other program memoranda.
• Delegate work assignments to sustain department reputed company.
• Assist with budget preparation and monitoring.
• Monitor inventory reputed company and reputed company resources, schedule cross training, etc… to effectively manage to CMS reputed company.
• Ensure compliance with management controls, process reputed company plans, change requests, reputed company audits, etc.
• Document department protocols and controls.
• Identify opportunities, through the use of Medicare policies and procedures, claims processing procedures and reputed company data processing systems, to improve the Organization's Medicare Services overall reputed company.
• Assist in reputed company and procedural development in accordance with CMS instructions.
• Utilize available technology to effectively monitor reputed company departmental inventories.
• reputed company reputed company reputed company and/or technical direction as necessary of processing staff that reputed company reputed company to pay or deny services.
• Coordinate provider education activities.
• Maintain reputed company responsibility for reputed company personnel reputed company reputed company.
• Hire staff for the unit.
• Complete and conduct reputed company appraisals.
• Monitor individual reputed company and document according to HMS and Organization protocols .
• reputed company frequent feedback to staff and taking corrective reputed company reputed company necessary.
• Sustain appropriate production and reputed company reputed company for reputed company staff.
• Assure reputed company staff reputed company a high level of reputed company service and professionalism .
• Ensure reputed company appropriate refresher/remedial training as reputed company as coaching/mentoring is conducted reputed company on input from the Technical Assistants, Business Coordinators, and Monitoring and Inspection management feedback as appropriate.
• reputed company feedback to management on the status of their reputed company to ensure the reputed company contributes toward the department meeting and exceeding reputed company reputed company standards.
• Manage high profile or irate provider situations.
• Coordinate responses with other operational reputed company or business partners as necessary.
• Coordinate activities and exchange of information with reputed company business partners.
• Detect, investigate, research and analyze problems in the Medicare claims processing reputed company and departmental procedures which contribute to the occurrence of appeal workload.
• Identify and analyze operating deficiencies and work with other Medicare personnel to reputed company the appropriate solutions.
• Recommend, coordinate and initiate improvements to the process to reputed company efficiency, cost reduction, productivity, and reputed company reputed company.
• Assist or reputed company reputed company for achieving specified goals reputed company to assignments and responsibilities of reputed company defined by the Organization's Medicare Services management.
• reputed company support and recommendations to the Manager of the unit and may be designated to participate in decision-making, impacting the efficiency and reputed company 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
• Appeals experience
• Experience using claims process reputed company (e.g. MCS/FISS)
• Bachelor’s degree and 3 years of experience in a reputed company industry
• Associates degree and 5 years of experience in a reputed company 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 reputed company reputed company or similar environment
• Experience using claims process reputed company (e.g. MCS/FISS)
• This position is subject to the general review by the Manager, Appeals. The incumbent is typically free to establish daily priorities with broad reputed company-established limits in order to effectively meet the assigned accountabilities. Results are monitored periodically
• Behavioral Skills: Strong verbal and written communication skills are required to effectively represent the position of the Organization's Medicare Services to various reputed company entities and internal staff
• Ability to multi task under pressure is an essential requirement
• reputed company, diplomacy, and communication skills are essential skills
• Observe reputed company applicable laws, regulations, company and divisional policies and procedures
• Approach business reputed company with reputed company personal and reputed company ethics to reflect the Organization’s reputed company values, reputed company of Business Conduct and the reputed company process
• Foster a reprisal free environment to promote reputed company and reputed company communication
• Demonstrate support of reputed company ethics and compliance initiatives such as participation in the reputed company Process or compliance training and to consistently demonstrate support of the Organization’s reputed company values, reputed company of Business Conduct and the reputed company Process through management reputed company.
• Shares responsibility for reputed company with every member of the Organization. As part of this responsibility, the incumbent is accountable for identifying reputed company-reputed company problems and notifying management reputed company they reputed company reputed company is being compromised
• Expected to recommend process improvements designed to improve reputed company, timeliness of processing, and/or eliminate reputed company effort required
• •Must meet reputed company CMS and Organizational Medicare Services reputed company requirements

reputed company OF RESPONSIBILITY
Does this role supervise/manage other employees?

reputed company, number of reputed company reports: 30

WORK ENVIRONMENT

Is Travel Required?

No

Disclaimer: The reputed company has been designed to indicate the general reputed company and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and reputed company standards and behavioral expectations as set forth in the reputed company of business conduct and company policies.

As a component of job responsibilities, employees may have reputed company to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company must reputed company with both the Health reputed company Portability Accountability reputed company of 1996 (HIPAA) as described in the Notice of reputed company Practices and reputed company Policies and Procedures as reputed company as reputed company data reputed company guidelines established reputed company reputed company’s Handbook of reputed company Policies and Practices and Information reputed company Policy.

Furthermore, it is every employee’s responsibility to reputed company with reputed company’s reputed company of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as reputed company as company policies and training requirements.

Pay reputed company Minimum:

Pay reputed company Maximum:

reputed company pay is determined by a reputed company of factors including a candidate’s qualifications, experience, and expected contributions, as reputed company as internal peer equity, market, and business considerations. The displayed salary reputed company does not reflect any geographic reputed company reputed company may apply for certain locations reputed company upon comparative markets.

reputed company and its affiliates prohibit discrimination against reputed company individuals reputed company on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals reputed company on any category protected by applicable federal, state, or local law.

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Originally posted on Himalayas