Denials and Appeals Specialist

4 weeks ago


Brentwood, Tennessee, United States Diversicare Healthcare Services & Diversicare Ther Full time
Job Summary

We are seeking a highly skilled Denials and Appeals Specialist to join our team at Diversicare Healthcare Services & Diversicare Ther. As a key member of our team, you will be responsible for maintaining an electronic tracking system for all ADRs, denials, and appeals, communicating and collaborating with centers to ensure timely responses to all claims, and submitting ADR documentation.

Responsibilities
  • Maintain an electronic tracking system for all ADRs, denials, and appeals.
  • Communicate and collaborate with centers to ensure timely responses to all claims.
  • Submit ADR documentation.
  • Write redetermination letters.
  • Follow each claim through each level of determination until resolved.
  • Scheduled and assist with ALJ hearings.
  • Maintain relationships with all fiscal intermediaries, MACS, CHS, insurance companies, and any other agencies as needed.
  • Maintain knowledge of trends and changes in ADR, denial, and Appeal process.
  • Prepare and gather records for outside reimbursement audits.
Qualifications
  • Current nursing license by state board of nursing (RN or LPN) or related Healthcare field.
  • Experience in SNF/LTC.
  • Experience in Clinical Software Systems.
  • Experience in minimum data set.

We offer a competitive salary and benefits package, including medical, dental, and vision insurance, excellent 401(k) plan, tuition reimbursement, vacation, holiday, and sick time, long and short-term disability, employee assistance program, life insurance, referral bonuses, and Diversicare's employee hardship fund.

At Diversicare, we are committed to providing exceptional healthcare services and exceeding expectations. Our core values of integrity, excellence, compassion, teamwork, and stewardship guide us in our mission to improve every life we touch.



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