ADR Billing Specialist
CommuniCare Health Services
full-time
Posted on:
Location Type: Remote
Location: Ohio • United States
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About the role
- 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
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
Benefits
- 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.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
billing processescase reviewclaims submissionaccount researchdata accuracyPDPMRUG scorescash postingsappeals processescalculating at risk amounts
Soft Skills
communication skills