ADR Billing Specialist

Role Overview

• 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
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