Medicare Appeals Supervisor — Lead & Optimize

Highmark Health; United States; Remote; USD 63,000 - 97,000; Full time

Job summary

Highmark Inc. is seeking a senior leader to supervise the Part A and Part B Medicare Fee-for-Service appeals unit within the Organization’s Medicare Services.

You will delegate assignments, manage resources to meet CMS thresholds and internal standards, and guide non-clinical staff in pay/deny determinations. Responsibilities include budget support, process quality compliance, communication with CMS, PSC/QIC and providers, and ongoing staff development.

Qualifications

• High School diploma or GED required.
• 1-3 years of leadership/supervisory experience.
• Bachelor’s degree preferred; 3 years healthcare industry experience.
• Associates degree with 5 years healthcare industry experience.
• 1-3 years Medicare Program or Medicare regulations experience.
• 3-5 years PC experience in Windows or similar environment.
• Experience using claims processing systems such as MCS/FISS.
• Strong verbal and written communication for external and internal audiences.
• Ability to multi-task under pressure and maintain quality.

Responsibilities

• Supervise the Medicare Appeals unit and delegate tasks.
• Monitor budget and performance against CMS thresholds.
• Ensure compliance with CMS requirements and internal controls.
• Coordinate provider education activities and external partner relations.

Skills

Medicare regulations

CMS guidelines

Leadership

Budget management

Verbal & written comms

Multi-tasking

Compliance & ethics

CMS audits

Staff development

Education

Bachelor’s degree in healthcare administration or related field

Associate’s degree in healthcare administration

Tools

MCS/FISS

Job description

Highmark Inc. is seeking a senior leader to supervise the Part A and Part B Medicare Fee-for-Service appeals unit within the Organization’s Medicare Services.

You will delegate assignments, manage resources to meet CMS thresholds and internal standards, and guide non-clinical staff in pay/deny determinations. Responsibilities include budget support, process quality compliance, communication with CMS, PSC/QIC and providers, and ongoing staff development.