Medicare Appeals Supervisor - FFS Leadership

Highmark Health; Northern (KY); Hybrid; USD 63,000 - 97,000; Full time

Job summary

Highmark Health seeks a leader to supervise the Medicare Appeals unit, overseeing Part A/B processes, budgets, and staff performance. You will direct technical and non-clinical staff, ensuring CMS thresholds and internal standards are met while coordinating with external partners and auditors.

The role requires strong communication, staff development, and the ability to manage complex Medicare service workflows and escalation paths.

Qualifications

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

Responsibilities

• Displays effective communication with Director and Senior Management and with external partners.
• Delegate work assignments to sustain department performance and assist with budget preparation and monitoring.
• Monitor inventory levels and move resources to effectively manage CMS thresholds.
• Ensure compliance with CMS requirements, internal audits and program memoranda.
• Provide direct oversight of processing staff decisions to pay or deny services.

Skills

Medicare regulations

Leadership

Windows / PC experience

MCS/FISS

Education

High School diploma or GED

Bachelor’s degree (preferred)

Associate degree in healthcare (preferred)

Tools

MCS/FISS

Job description

Highmark Health seeks a leader to supervise the Medicare Appeals unit, overseeing Part A/B processes, budgets, and staff performance. You will direct technical and non-clinical staff, ensuring CMS thresholds and internal standards are met while coordinating with external partners and auditors.

The role requires strong communication, staff development, and the ability to manage complex Medicare service workflows and escalation paths.