Supervisor Appeals - Medicare

Location: Remote, work at home in Pennsylvania, United States

Company

hirify.global operates Medicare Services and manages Medicare fee-for-service appeals activities.

What you will do

• Supervise the Part A and/or Part B Medicare fee-for-service appeals unit and delegate assignments to appeal representatives and technical staff.
• Manage workloads, inventory, staffing, cross-training, and resources to meet CMS thresholds and internal performance standards.
• Oversee staff making service payment or denial determinations and maintain responsibility for hiring, performance reviews, coaching, and corrective action.
• Ensure compliance with CMS requirements, management controls, quality plans, change requests, and internal and external audits.
• Communicate with CMS, providers, beneficiaries, authorized representatives, contractors, vendors, and internal stakeholders.
• Investigate claims-processing and procedural deficiencies and coordinate improvements that increase efficiency, quality, accuracy, and productivity.

Requirements

• High school diploma or GED.
• 1–3 years of experience in a leadership or supervisory position.
• 1–3 years of experience working with the Medicare program or Medicare regulations.
• 3–5 years of experience using a personal computer in Microsoft Windows or a similar environment.
• Experience with a claims processing system such as MCS or FISS.
• Strong verbal and written communication, multitasking, tact, diplomacy, ethics, and commitment to CMS and organizational security requirements.

Nice to have

• Bachelor’s degree and three years of healthcare industry experience.
• Associate degree and five years of healthcare industry experience.

Culture & Benefits

• Remote work-from-home arrangement in Pennsylvania.
• Opportunity to lead a unit with approximately 30 direct reports.
• Focus on ethical conduct, compliance, quality, and a reprisal-free communication environment.
• No travel is required.