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Liberty Healthcare Management

Come explore career opportunities with Liberty Healthcare Management, a dynamic leader in the healthcare industry. Join us!

We are currently seeking an experienced:

SNF ADR and Appeals Nurse

Full Time, Days

JOB SUMMARY:

• Review Medicare and Managed Care contractor records request and response letters in comparison to client medical records
• Communicate with offices/facilities for initial records requests
• Communicate with offices/facilities regarding missing or insufficient medical documentation
• Gather, organize, scan and submit additional documentation requests (ADRs) timely
• Review SNF denials and medical documentation for adherence to Medicare guidelines relating to provided services (or other Medicare issues) and draft appropriate appeal letters based upon professional clinical opinion as to the medical necessity of the services provided
• Complete data entry in the company's software.
• Organize, review and scan completed records, as needed into Waystar system and in company intranet folders for archiving.
• Submit documentation as needed through EsMD system, via USPS mail (for contractors that do not receive through EsMD) and via managed care portals.
• Maintain a monthly Report log of the biggest issues/reasons for denials for both managed care and Medicare submissions. Submit report to the Reimbursement Appeals Director by the fifth of each month for the previous month.
• Assist with ALJ appeal preparation and presentation as necessary
• Operate a motor vehicle
• Meet daily minimum expectation for assigned tasks
• Perform other related duties as required

JOB REQUIREMENTS:

• RN licensure required
• Medicare and Managed Care ADR and Appeals experience preferred
• Minimum 2 years MDS coordinator experience required with PDPM coding experience preferred
• Minimum 3+ year's recent clinical nursing experience in the SNF setting
• Proficient in keyboarding
• Experience with Microsoft Office
• Ability to learn and understand various clinical software applications
• Strong deductive reasoning and multitasking ability
• Excellent problem-solving skills
• Self-motivation and ability of working independently with limited supervision and structure
• Excellent interpersonal, verbal, and written communication skills
• Must have a valid drivers' license

Visit www.libertycareers.com for more information.
Background checks/drug-free workplace.
EOE.

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