Medicare Appeals Lead — Strategy & Oversight

Highmark; United States; On-site; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. is seeking a supervisor for the Medicare Appeals unit. The role oversees Part A and/or Part B appeals, delegates staff, and manages resources to meet CMS thresholds and internal standards.

The position contributes to budget preparation and ensures compliance with CMS and organizational policies while coordinating with external entities and providing leadership across a team of non-clinical staff.

Qualifications

• High School diploma or GED.
• 1-3 years of experience in a leadership/supervisory position.
• Bachelor’s degree and 3 years of experience in a healthcare industry.
• Associates degree and 5 years of experience in a healthcare industry.

Responsibilities

• Supervise the Medicare Appeals unit and delegate assignments.
• Assist with budget preparation and monitor performance toward budget.
• Ensure CMS and internal audits compliance across processes.
• Coordinate with external entities (CMS, PSC, RAC, QIC) on issues.
• Maintain staff performance, provide feedback, and conduct appraisals.
• Identify opportunities to improve claims processing performance.

Skills

Leadership experience

Verbal and written communication

Budget monitoring

CMS compliance

Staff supervision

Problem solving

Education

High School diploma or GED

Bachelor's degree

Associates degree

Tools

Claims processing system (MCS/FISS)

Microsoft Windows

Job description

Highmark Inc. is seeking a supervisor for the Medicare Appeals unit. The role oversees Part A and/or Part B appeals, delegates staff, and manages resources to meet CMS thresholds and internal standards.

The position contributes to budget preparation and ensures compliance with CMS and organizational policies while coordinating with external entities and providing leadership across a team of non-clinical staff.