What are the responsibilities and job description for the ADR Billing Specialist position at CommuniCare Family of Companies?
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 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
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