ADR Coordinator & Clinical Compensation Specialist | Hybrid

HCF Management, Inc.•Lima, OH

2d•Hybrid

About The Position

The ADR Coordinator oversees the response process on behalf of assigned HCF Care Communities for any appeal, review, or denial of pre/post payment for services provided. This role involves researching medical records, preparing documents, and generating responses to CMS or other third-party payers. The specialist will analyze initial documentation and billing processes to identify necessary changes to prevent future appeals, reviews, or denials. Collaboration with the Billing department, Regional Nurses, and Therapy vendors is key to establishing a system that reduces appeals and reviews. Additionally, the role includes providing education to employees to ensure processes are in place to avoid future denials and may require travel to assigned HCF Care Communities.

Requirements

Licensed Practical Nurse in State of Ohio (Registered Nurse preferred)
3 years’ experience in Long-term care field
MDS or Case Management experience is necessary

Nice To Haves

Experience in a position with similar goals and responsibilities
Compassionate, team players, social, trustworthy and service-minded
Self-motivated, dependable, ethical, and ready to jump in and provide outstanding care and customer service to our residents

Responsibilities

Coordinates the response process on behalf of assigned HCF Care Communities for any appeal, review or denial of pre/post payment for services provided.
Researches medical records, prepares documents, and generates ADR and appeal responses to CMS or other 3rd party payers.
Analyzes the initial documentation/billing processes to determine necessary changes to avoid future appeals, reviews or denials.
Collaborates with Billing department, Regional Nurses, Therapy vendor and other resources to establish a system resulting in a reduction of appeals and reviews for submitted claims.
Provides appropriate education to employees to ensure processes are in place to avoid future denials.
Ability to travel to assigned HCF Care Communities as necessary based on ADR, appeals, and review activity.