ADR Billing Specialist

The CommuniCare Family of Companies is currently hiring for an ADR Billing Specialist.Requirements:Have an understanding of Medicare, Managed Care and Medicaid.Background in Long Term Care billing processesPreferred background in Medicare, Managed Care and Medicaid billingPreferred knowledge of Point Click Care, Quadax and PrimeClaimsUnderstanding of ADR and appeals processes and workflowsUnderstanding of collections processesStrong communication skillsJob Duties:Reviewing cases for Part B therapy appealsLogging therapy appeal cases in AxisSubmitting 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 authorizationFollowing up on appeals with auditing contractors and payersSubmitting write offs on accounts deemed uncollectibleNotating on accounts in PCC in compliance with the dashboard collection policyAccount research as it pertains to cash postings and adjustmentsMonitoring the ADR payersEnsuring proper logging and statusing of all ADRs and therapy appeals in AxisAssisting with report set up to ensure accuracy of dataSet up for electronic eMDR notification in NPPESWaystar for Medicare pre and post pay ADRsAssisting with electronic notification set up for other various ADRsCalculating at risk amounts for partially favorable ADRs required knowledge of updatingchanging PDPMRUG scores in PCC to obtain difference, and knowing what dates of service to change, and appropriately changing backOther duties as assigned

Created: 2025-02-21