Supervisor, Appeals-Medicare vacancy at Highmark in Pittsburgh

Highmark is at present looking to employ Supervisor, Appeals-Medicare on Tue, 26 Mar 2013 08:56:29 GMT. * Supervise Medicare and Medcaid appeals unit within Gateway Health Plan * Delegation of assignments to appeal representatives and technical staff * Manage resources to ensure CMS, DOH, and DPW thresholds and internal customer standards are achieved in all workloads within the unit (appeals, grievances, complaints * Assistance with budget preparation and monitoring of performance towards budget...

Supervisor, Appeals-Medicare

Location: Pittsburgh, Pennsylvania

Description: Highmark is at present looking to employ Supervisor, Appeals-Medicare right now, this vacancy will be presented in Pennsylvania. More details about this vacancy opportunity kindly read the description below.

• Supervise Medicare and Medcaid appeals unit within Gateway Health Plan
• Delegation of assignments to appeal representatives and technical staff
• Manage ! resources to ensure CMS, DOH, and DPW thresholds and internal customer standards are achieved in all workloads within the unit (appeals, grievances, complaints
• Assistance with budget preparation and monitoring of performance towards budget
• Ensure compliance with all corporate standards as well as all CMS DOH, and DPW requirements as they relate to change requests, management controls, process quality plans, internal and external audits, etc....
• Responsible for the direct oversight and/or technical direction of non-clinical staff that make determinations to pay or deny services, identify provider education opportunities, and appropriate referrals to other contractors (DOH External Reviewer enitity, Qualified Independent Contractor (QIC) for second level appeals, etc...)
• Communicate with/educate external entities including CMS, DOH, DPW, Office of Inspector General, and Attorney General appellants and their authorized representatives, etc..! . on appeal related issues

Required Qualificatio! ns:

• High School diploma or GED
• 1-3 years experience in a leadership/supervisory position

Preferred Qualifications:

• Bachelor's degree and 3 years experience in healthcare industry
• Associates degree and 5 years experience in healthcare industry
• 1-3 years experience working in Medicare Program or with Medicare regulations
• 3 -- 5 years of experience working on a personal computer in Microsoft Windows or similar environment
• Experience using claims process system (e.g. MCS/FISS)

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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Highmark.

Interested on this vacancy, just click on the Apply button, you will be redirected to the official website

This vacancy will be started on: Tue, 26 Mar 2013 08:56:29 GMT

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