Medicare Specialist Supervisor

Medicare Specialist Supervisor

 

Hill-Rom has been an industry leader in providing customers with high-quality, innovative products and outstanding services in the health care industry since 1929.  The company is a subsidiary of Hillenbrand Industries (NYSE:HB) and currently employs more than 6,500 people worldwide, including approximately 2,000 at its global headquarters.  Our mission is simple: Everyday we strive to make a positive difference in the lives of patients and those who care for them.

 

Hill-Rom offers its associates challenging work experiences, a collaborative team environment, and an atmosphere to continually develop your career. However, the strongest reason for working at Hill-Rom is the opportunity to put your passion for making a difference to work.

 

We are currently seeking a Medicare Specialist Supervisor for our St. Paul, MN location.  We offer an excellent compensation package and comprehensive benefits, including: competitive salary, 401K, Medical, Dental, Vision, Life Insurance and tuition reimbursement.

 

JOB SUMMARY:  This position will supervise a team of Medicare Appeal Specialist and Medicare Clinical Reviewers.  Will be participating in the hiring process and the termination process.  Will be responsible for work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  Supervise Clinical Reviewers and Appeal Specialist to ensure maximum potential.Provide support  and guidance to staff and clients when coverage for the Vest is denied.Provide guidance and assess cases, develop appeal strategies, and set timelines to ensure appeal deadlines are met.  Provide guidance on prioritize workload based on clinical strength of cases and potential for approval.Coordinate problematic Appeals and Clinical Reviews with management.Monitor and evaluate team effectiveness and individual productivity measured against established performance standards. Apply corrective measures as appropriate to ensure standards are maintained and goals are achieved. Monitor the Clinical Reviewer and Appeal Specialist business processes and the J.D.Edwards (JDE)  System to maintain patient account accuracy and data integrity.Prepare periodic reports on team effectiveness in meeting established production and quality standards.Monitor and evaluate individual performance, provide individual performance feedback and accomplish individual annual reviews on assigned staff (APEX).Work with internal departments to strategize appropriate process changes in supporting Medicare Clinical Review and Medicare Appeals.Assist staff in complete appeals correspondence in a professional and persuasive manner.  Provide patient-specific information and relevant diagnosis to support appeals.  Identify appropriate resolution for files if denials are upheld by Medicare.Identify payer trends and establish payer-specific strategies for non-covered diagnoses.Other duties may be assigned.



EDUCATION AND/OR EXPERIENCE REQUIRED:

  Associates degree or higher; or equivalent work experience.LPN or RN license preferred.Minimum five years experience with Medicare/Third party payer required.Experience conducting effective meetings, briefings and presentations.Knowledge of federal, state, and local regulations, guidelines, and standards, including a working knowledge of HIPAA rules and regulations. Proven excellent verbal and written English language skills both up and down the organization as well as externally with customers, payers and patients.Ability to develop strong team environment.Strong organizational skills.Knowledge of Medicare Regulations.  Previous supervisory responsibilities preferred.



To apply, please use the following link:

https://v2.projectix.com/hill-rom/jobboard/NewCandidateExt.aspx?__JobID=2177

 

At Hill-Rom, we strive to build a diverse work force through equal opportunity

employment that embraces and leverages the differences each individual has to offer.

 

M/F/D/V

 NOTICE: All applicants receiving offers of employment will be required to pass a drug screen and criminal background check as a condition of hire.  It is the policy of the Company to maintain a safe workplace free of the influence of illegal drugs and to vigorously comply with the requirements of the Drug Free Workplace Act of 1988.