ADR Billing Specialist

CommuniCare Health Services•Akron, OH

7d•Remote

About The Position

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. 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.

Requirements

Have an understanding of Medicare, Managed Care and Medicaid.
Understanding of ADR and appeals processes and workflows
Understanding of collections processes
Strong communication skills

Nice To Haves

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

Responsibilities

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