ADR Specialist

MISSION POINT HEALTHCARE SERVICES Delivering Excellence.
Every Life.
Every Moment.
Every Day.
Position Summary: The ADR Specialist is to protect the assets of the Company and ensure regulatory compliance through a timely and accurate review, and submission of assessments to ensure optimal reimbursement of services in accordance to Medicare, Medicaid, BRA, and other payer program requirements in accordance of federal and state guidelines.
Principal Duties and Responsibilities: Works with the Medical Records Department/Facilities to ensure that necessary supporting documentation is available for claim/record requests.
Reviews the requested record for required documentation and signatures prior to sending to the payer/requesting party.
Develops, monitors, and assesses ADR/Record request denials to refine processes and improve performance.
Directs resolution of billing and payment issues and ensures proper communication to the billing department and executive leadership team in accordance with established parameters.
Ensures analysis and correction of root causes of denials, billing errors, database errors, etc.
that result in non-payment or denied claims.
Collaborates with other departments, especially Billing and the Quality and Reimbursement Directors, to design systems, train staff, implement monitor and implement changes needed to reduce claim denials.
Responsible for notifying management and departmental staff of any changes that will affect billing and coding guidelines.
Regularly provides upper management with reports, metrics, and trending of ADR and denial requests.
Communicates with the physicians/facility leadership members to resolve coding and documentation discrepancies.
Responsible for counseling departmental staff on all discrepancies that affect billing and coding guidelines.
All other duties assigned.
Required/Desired Qualifications: Education, Training, and Experience: Maintain an active RN Licensure in the state of Michigan.
Must have experience in Medicare program management / billing documentation requirements.
Strong understanding of Medicare Advantage, supplemental, Medicare Part D, and Managed Medicaid plans.
In-Depth knowledge of Medicare regulations and compliance requirements.
Must have good communication and interpersonal skills, with the ability to explain complex Medicare and other third-party payer concepts.
Minimum Associates Degree in related field and/or 3 years work experience in related healthcare field.
Who we are: Mission Point is a full-service healthcare organization with special focus on Long Term care and Short-term Nursing & Rehabilitation.
Founded in 2012 and with 26 facilities across Michigan and Nevada, Mission Point’s goal is to provide the highest level of quality of care in a compassionate and safe environment.
Mission Point helps its residents live a healthy, happy, and productive lifestyle.
Mission Point Healthcare Services is an equal opportunity employer.
All qualified candidates will receive consideration without regard to race, color, religion, sex or national origin.
#MPNL About Mission Point Health Care Services : MISSION POINT HEALTHCARE SERVICES We are a full-service health care services and management company, with a specific focus on long-term skilled nursing care and assisted living.
Mission Point offers healthcare services right in your community.
Whether your needs are short-term skilled nursing & rehabilitation care, long-term care, hospice care or respite care, Mission Point’s goal is to provide the highest level of quality of care in a compassionate and safe environment.
Mission Point helps its residents live a healthy, happy and productive lifestyle.