Job Description

Atrium Centers…Be a light…to all residents, their families and team members

“Our mission is to serve as a bright light in the lives of our residents and families by delivering compassionate, quality care in the communities they call home”. Our foundation is based upon Compassion, Community and Clinical Excellence.

Job Summary:

As the Medicare Appeals Manager you will be responsible for intake and processing of all documentation requests from Medicare and Managed Care claim reviews, denials, and appeals. This individual will also assist with auditing medical records for Medicaid Case-Mix reviews.

*This position is located on site Monday- Friday at our corporate offices in Columbus, Ohio.

Essential Job Functions:

• Reviewing Cases within regulatory timeframe.
• Address urgent and emergency cases.
• Researching issues to mitigate risk.
• Works closely with a variety of internal Atrium departments.
• Address and identify areas for further training or development based on identified issues and requests.

Qualifications:

• Qualified applicants include Licensed Practical Nurse (LPN), Physical Therapy Assistant (PTA), Certified Occupational Therapy Assistant (COTA).
• Must have PDPM/RAI experience
• Medicaid Case-Mix experience preferred
• Minimum of 2-3 years of long-term care experience
• Must possess an understanding of skilled nursing facility Medicare requirements of eligibility
• Managed Care experience preferred
• Appeals experience preferred
• Must have CPT and/or ICD10 experience
• Must have experience with Microsoft excel and word, as well as Adobe Pro
• Must have excellent communication skills to collaborate with facility team members, as well as provide one-on-one or group trainings when needed
• Must be willing to take on additional projects from supervisor when denials/appeals are slow

We are Atrium Centers, and we invite you to see—first-hand—what we’re all about. If you’re committed to delivering compassionate, quality care in your local community, and believe in taking an all-hands, all-hearts approach to delivering top-notch care.

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