ADR and Appeals Manager
Company: Laurel Health Care Company
Location: Westerville
Posted on: June 25, 2025
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Job Description:
The ADR and Appeals Manager is responsible for the oversight and
management of all aspects of the Additional Documentation Request
(ADR) and appeals process for Ciena Healthcare. This individual
ensures compliance with Medicare, Medicaid, and other third-party
payer requirements, while working collaboratively with clinical,
billing, and legal teams to support timely, accurate, and
defensible responses to audits, denials, and appeals. Join us with
an attractive benefits offering: Competitive pay Medical, dental,
and vision insurance 401K with matching funds Life Insurance
Employee discounts Tuition Reimbursement Student Loan Reimbursement
Responsibilities: ADR Management: Receive, log, and track all ADRs
from payers (Medicare, Medicaid, private insurers). Coordinate with
3rd party vendor the collection and submission of required
documentation within specified deadlines. Ensure documentation
accuracy, completeness, and compliance with payer requirements.
Maintain organized and secure records of all ADRs and responses.
Appeals Coordination: Manage and oversee the entire appeals process
from initial denial through final resolution. Draft, review, and
submit appeals, including reconsideration and administrative law
judge (ALJ) levels as necessary. Collaborate with legal counsel and
external consultants on complex cases as needed. Conduct root cause
analysis of denials to identify patterns and prevent future
occurrences. Communication & Collaboration: Liaise with facility
staff, therapy providers, billing teams, and medical records
departments to gather necessary documentation. Serve as the point
of contact for auditors and external reviewers. Communicate updates
and outcomes to leadership and relevant stakeholders. Education &
Compliance: Train facility and regional teams on documentation best
practices to reduce denial rates. Keep current with regulatory and
payer changes affecting ADR and appeals processes. Develop and
update internal policies and procedures related to ADRs and
appeals. Reporting & Metrics: Maintain tracking systems to monitor
ADR and appeal status, volumes, and outcomes. Generate regular
reports for senior leadership detailing trends, risks, and
opportunities for improvement. Requirements: Bachelor’s degree
preferred in health information management, Nursing, Healthcare
Administration, or related field required. RHIA, RHIT, RN, or
equivalent preferred. Minimum of 3–5 years of experience in
healthcare reimbursement, appeals, or compliance, preferably in the
skilled nursing or long-term care sector. Strong knowledge of MDS
3.0, PDPM, Medicare/Medicaid regulations, audit procedures, and
appeal rights. Ability to manage multiple deadlines and coordinate
cross-functional teams. Proficiency in Microsoft Office Suite and
experience with EHR and billing systems. Familiarity with MACs,
RACs, UPICs, and ZPICs. Ability to travel as needed. Ciena
Healthcare We are a national organization of skilled nursing,
subacute, rehabilitative, and assisted living providers dedicated
to achieving the highest standards of care in five states including
Michigan, Ohio, Virginia, North Carolina, and Indiana. We serve our
residents with compassion, concern, and excellence, believing that
every one of them is a unique person who deserves our best each day
that we care for them. Join us, if you have a passion for improving
the lives of those around you and working with others who feel the
same way. IND123
Keywords: Laurel Health Care Company, Hamilton , ADR and Appeals Manager, Healthcare , Westerville, Ohio
