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ADR Specialist

Location: 

Coral Springs, FL, US

Job Family:  Finance
Country/Region:  United States
 

Job Function Summary

  • Maintain all documentation associated with the processing and handling of ADR’s, Medicare TPE’s. requests for medical records and appeals to comply with regulatory standards and time frames while maintaining an accurate, complete appeals record.

 

Major Areas of Accountability

  • Responsible for knowing and adhering to all Medicare LCD’s & policy articles, pertaining to services and products provided.
  • Responsible for accurately interpreting explanation of benefits (EOB’s) provided by various payers.
  • Responsible for navigating between multiple computer-based systems to accurately review and/or gather documentation to respond to audits/appeals as assigned.
  • Responsible for identifying deficiencies and/or resolving discrepancies in documentation while complying with company policies & procedures and informing supervisor when a resolution cannot be attained.
  • Ensure audit/appeal assembled packets does not contain any omissions and/or deficit information.
  • Properly submit patient and physician records to customers in a timely manner adhering to the deadline dates outlined in the Audit Database.
  • Responsible for correctly uploading assembled packets in the appropriate location for archiving purposes.
  • Responsible for understanding how and when to update the Audit Database pertaining to, but not limited to adding & removing deadline dates, documentation flags, and closing out audits/appeals.
  • Responsible for following up on pending audits/appeals to ensure missing/invalid documentation is being chased when necessary, ensuring compliant documentation is readily available before deadline date.
  • Perform administrative activities, including but not limited to generating, printing, mailing, faxing and portal submissions of valid audit/appeal packets. 
  • Effectively communicates with Comfort Medical staff as needed pertaining to denials, audits and appeals outlined by company policies and procedures.
  • Responsible for achieving and maintaining individual, department and company goals.
  • Perform administrative activities, including but not limited to generating, printing, mailing, faxing and portal submissions of valid audit/appeal packets. 
  • Capable of assisting with incoming/outgoing calls as needed pertaining to requested documentation from physician offices.
  • Responsible for keeping Manager/Director informed of deficient appeal cases, patterns of appeals, claim errors, or other systemic problems identified during daily tasks.
  • Responsible for additional duties as directed by the department’s management.

 

Basic Qualifications

  • High school diploma or equivalent.
  • Minimum of 3 years medical records experience (data entry, processing and customer service).
  • Ability to work independently and stay on task.
  • Strong background and proven success in collections and negotiation skill.
  • Excellent medical terminology skills.
  • Excellent written and verbal communication skills.

 

Preferred Qualifications

  • DME collections experience
  • NobleHouse system experience

 

Comfort Medical provides an extensive selection of name brand catheter and ostomy supplies to thousands of customers nationwide. Our attention to detail, unmatched customer service, and dedication to helping our customers live happier, healthier lives are just a few of the many reasons we are one of the fastest growing catheter and ostomy supply companies in the nation!​

 

Comfort Medical is committed to a policy of Equal Employment Opportunity (EEO) which means we employ and promote individuals based on their merits, regardless of race, color, religion, sex, national origin, age, disability, veteran status, pregnancy, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, status with regards to public assistance or any other protected classification.

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Nearest Major Market: Fort Lauderdale
Nearest Secondary Market: Miami

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