ADR Specialist

PACS is elevating healthcare in the post-acute care space by delivering on our mission and values to create real change.

By striving for the best while staying true to who we are, we're forging a bright future for post-acute care delivery and support across the nation.

Our company is growing quickly and has many exciting milestones ahead of us.

This means at PACS you will have plenty of opportunities to engage in exciting work as you grow and develop in your career.

Note: This position is a full-time REMOTE role.

General Purpose

The primary purpose of your job position is to support, teach, monitor, and communicate with facility staff the risk from additional documentation requests and ensure the PACS ADR process is followed to minimize risk of recoupment from all payers.

ADR Process covers requests and denials from all payers and includes probes, RAC's , TPE's, SMRC's, UPIC's, CERTs, ADR's, etc.

Essential Duties

• Routinely post ADR information to ADR Tracking log as it becomes available

o New ADRs

o Updates to ADRs

o Resolved ADRs

• Participate in Weekly ADR Review of all Sites with RN Compliance Nurse

• Report unusual ADR notifications or concerns to QAS or SDOC

• Troubleshoot ADR Access issues with PACS IT/Facility Team member

• Post ADR Results to Reasons for Denials Log

• Maintain Probes in Progress Spreadsheet and be able to provide data as needed

• Maintain current ADR Regional Staff listing

• Maintain Historical ADR Data on ADR Tracking Log

• Maintain tracking of education on ADR Process

• Identify ADR Training needs and report to QAS or SDOC

• Maintain Vendor ADR Contacts

• Ensure facilities are filling in their ADR files correctly

• Ensure facilities post all new denial requests

• Ensure facilities follow overall ADR process and notify all vendors when appropriate

• Follow email trail closely to ensure no deadlines are missed

Qualification

Education and/or Experience LVN degree, BS, MS or AA degree, Proficient in computer skills such as inputting data into programs such Excel and Word, SharePoint, some exposure helpful to Net Health and Point Click Care.

Language Skills Ability to read technical procedures.

Ability to read and comprehend policy and procedure manuals.

Ability to effectively present information and respond to questions from managers, coworkers, and professionals at insurance companies including MAC's

Mathematical Skills Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.

Reasoning Ability Ability to solve practical problems and do root cause analysis.

Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Certificates, Licenses

Registrations LVN or other degree