Director Denials and Appeals Management

Overview

At Diversicare, we're more than just a company – we're a passionate community dedicated to caregiving excellence. If you're driven by a desire to make a difference in the lives of patients and residents, then we invite you to be part of our extraordinary team.

Why Choose Diversicare:

• We're Proudly Agency-Free: Unlike other companies, we believe in building a direct connection with our team members, fostering trust, respect, and collaboration.
• Compassion-Driven Culture: At Diversicare, we value trust, respect, customer focus, compassion, diplomacy, appreciation, and strong communication skills. We're committed to creating a warm, caring, safe, and professional environment for both our customers and our team.
• Competitive Benefits: We offer a comprehensive benefits package that includes medical/dental/vision coverage, an excellent 401k plan, tuition reimbursement, vacation, holiday, and sick time, long and short-term disability, and much more.
• Room for Growth: Join a dynamic environment where you can grow in your career and make a lasting impact on the healthcare industry.
• Meaningful Mission: Our mission is to "Improve every life we touch by providing exceptional healthcare and exceeding expectations." A mission we truly live and breathe.
• Core Values: We are guided by five core values - Integrity, Excellence, Compassion, Teamwork, and Stewardship, as well as 12 Service Standards.

Ready to be a part of our compassionate team? Apply now and help us make a difference in the lives of our patients and residents. Join Diversicare Healthcare Services today!

Responsibilities

As the Director of Denials and Appeals you will Develop, Implement and Maintain a Denials/Appeals Management program for all payer types. This will include creation and maintenances of tracking system for all ARDS/Denials with full responsibility for following each claim through each level of appeal.

1. Create and maintain an electronic tracking system for all adrs, denials, and appeals.2. Communicate and collaborate with centers to ensure timely responses to all claims.3. Submit ADR documentation4. Write or oversee writing of redetermination letters.5. Follow each claim through each level of determination until resolved.6. Scheduled and assist with ALJ hearings7. Trend data gathered from ADRS and Denials for process improvement8. Prepare regular reports regarding number of ADRS, Denials, appeals and the financial impact.9. Teach and train on ADR and Denial process.10. Collaborate with all departments regarding quality assurance and process improvement opportunity opportunities identified from trending data.11. Maintain relationships with all fiscal intermediaries, MACS, CHS, insurance companies and any other agencies as needed.12. Maintain knowledge of trends and changes in ADR, denial and Appeal process.13. Prepare and gather records for outside reimbursement audits.

Qualifications

1. Current Nursing License by state board of nursing (RN preferred) or related Healthcare field2. Experience in SNF/LTC3. Experience in Clinical Software Systems4. Experience in Business analysis, adult education, quality assurance and process improvement leadership.