Medicare Appeals Supervisor: Lead & Optimize Outcomes

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

Job summary

Highmark Health seeks a seasoned supervisor to lead the Part A and Part B Medicare Fee-for-Service appeals unit. You will delegate tasks, manage staff, and drive performance toward CMS thresholds while assisting with budgeting and compliance with corporate standards and audits.

Experience with Medicare regulations and claims processing systems (MCS/FISS) is essential. You will coordinate with PSC/QIC and other contractors to ensure timely, accurate determinations.

Qualifications

• Leadership/supervisory experience in a healthcare setting.
• Experience with Medicare program regulations and appeals.
• Experience using claims processing systems (e.g., MCS/FISS).

Responsibilities

• Oversee Part A and/or Part B Medicare FFS appeals unit.
• Delegate assignments and manage staff.
• Assist with budget preparation and tracking.
• Ensure CMS thresholds and internal standards are met.
• Coordinate with external contractors and CMS.
• Maintain compliance with CMS changes and audits.

Skills

Leadership

Medicare knowledge

Appeals experience

Budgeting

Communication

Team coordination

Education

High School diploma or GED

Bachelor’s degree in healthcare

Associates degree in healthcare

Tools

MCS/FISS

Job description

Highmark Health seeks a seasoned supervisor to lead the Part A and Part B Medicare Fee-for-Service appeals unit. You will delegate tasks, manage staff, and drive performance toward CMS thresholds while assisting with budgeting and compliance with corporate standards and audits.

Experience with Medicare regulations and claims processing systems (MCS/FISS) is essential. You will coordinate with PSC/QIC and other contractors to ensure timely, accurate determinations.