ADR Billing Specialist at CommuniCare Health Services

Akron, Ohio, United States -

Full Time

Start Date

Immediate

Expiry Date

06 Jun, 26

Salary

0.0

Posted On

08 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medicare, Managed Care, Medicaid, Long Term Care Billing, Point Click Care, Quadax, PrimeClaims, ADR, Appeals Processes, Collections Processes, Communication Skills, Claim Submission, Account Research, PDPM, RUG Scores

Industry

Hospitals and Health Care

Description

Job Address: 10123 Alliance Road Blue Ash, OH 45242 The CommuniCare Family of Companies is currently hiring for an ADR Billing Specialist. We are willing to consider fully remote candidates for this role. WHAT WE OFFER Beyond our competitive wages, we offer all full-time employees a variety of benefit options including: Life Insurance LTD/STD Medical, Dental, and Vision 401(k) Employer Match with Flexible Spending Accounts NOW OFFERING DAILY PAY! WORK TODAY, GET PAID TOMORROW. Requirements: Have an understanding of Medicare, Managed Care and Medicaid. Background in Long Term Care billing processes Preferred background in Medicare, Managed Care and Medicaid billing Preferred knowledge of Point Click Care, Quadax and PrimeClaims Understanding of ADR and appeals processes and workflows Understanding of collections processes Strong communication skills Job Duties: Reviewing cases for Part B therapy appeals Logging therapy appeal cases in Axis Submitting therapy appeals to the appropriate payer via their web portals (IE: Availity, Buckeye, Caresource, etc.) Submitting corrected claims to various Managed Care payers for missing authorization Following up on appeals with auditing contractors and payers Submitting write offs on accounts deemed uncollectible Notating on accounts in PCC in compliance with the dashboard collection policy Account research as it pertains to cash postings and adjustments Monitoring the ADR payers Ensuring proper logging and statusing of all ADRs and therapy appeals in Axis Assisting with report set up to ensure accuracy of data Set up for electronic eMDR notification in NPPES/Waystar for Medicare pre and post pay ADRs Assisting with electronic notification set up for other various ADRs Calculating at risk amounts for partially favorable ADRs required knowledge of updating/changing PDPM/RUG scores in PCC to obtain difference, and knowing what dates of service to change, and appropriately changing back Other duties as assigned About Us Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 130 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 16,000 employees across several states. As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and is a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work, and families to heal. Since 1984, CommuniCare Family of Companies has been committed to delivering exceptional person-centered care as a national leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, and long-term care facilities deliver sophisticated and transformative care to nearly 16,000 residents and patients at any given time. CommuniCare employs more than 19,000 employees across six states (Ohio, Indiana, Maryland, Virginia, West Virginia and Pennsylvania). As a family owned and operated company, family and heart are woven into every aspect of our continuum of care. Our mission, to serve with pride, is evident and a quality residents, families and community partners have come to expect and trust. Dedicated to improving the lives of seniors, we put extraordinary service above all else. We continue to raise the bar and innovate wherever possible to deliver a higher quality of life for those far beyond our facilities. Because of this, our facilities are a better place for residents to live, patients to stay, employees to work and families to heal.

Responsibilities

Key duties involve reviewing and submitting therapy appeals to appropriate payers via web portals, following up on appeals with auditing contractors, and managing write-offs on uncollectible accounts. The specialist will also be responsible for monitoring ADR payers, ensuring proper logging in Axis, and assisting with report setup for data accuracy.