Medicare Appeals Operations Leader

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

Job summary

Highmark Inc. is seeking an experienced supervisor for the Part A and Part B Medicare Fee-for-Service appeals unit within Medicare Services.

You will delegate assignments to appeal representatives and technical staff while managing resources to meet CMS thresholds and internal standards. The role includes budget assistance, monitoring performance toward budget, ensuring compliance with CMS instructions, and direct oversight of non-clinical staff that decide to pay or deny services.

Qualifications

• Leadership/supervisory experience required.
• Experience with Medicare services and claims processing.
• Knowledge of CMS instructions and program requirements.

Responsibilities

• Display strong verbal and written communication with leadership and staff.
• Delegate tasks to sustain department performance and manage budgets.
• Assist with budget preparation and monitoring.
• Identify opportunities to improve performance using CMS policies.
• Provide oversight of processing staff in pay/deny decisions.
• Coordinate education activities and respond to provider situations.

Skills

Leadership

Communication

Budgeting

Team management

Multi-tasking

Ethics/compliance

Education

High School diploma or GED

Bachelor’s degree and 3 years of experience in a healthcare industry

Associates degree and 5 years of experience in a healthcare industry

Tools

MCS/FISS

Windows

Job description

Highmark Inc. is seeking an experienced supervisor for the Part A and Part B Medicare Fee-for-Service appeals unit within Medicare Services.

You will delegate assignments to appeal representatives and technical staff while managing resources to meet CMS thresholds and internal standards. The role includes budget assistance, monitoring performance toward budget, ensuring compliance with CMS instructions, and direct oversight of non-clinical staff that decide to pay or deny services.