ADR & Reimbursement Compliance Specialist
A growing multi-state healthcare organization is seeking a ADR & Reimbursement Specialistto oversee and coordinate responses to Additional Documentation Requests (ADRs) from Recovery Audit Contractors (RAC), Medicare Administrative Contractors (MAC), and Managed Care payers for Skilled Nursing (SNF) and Long-Term Care (LTC) facilities.
This role partners closely with facility leadership, compliance, and billing teams to ensure accurate, timely documentation submissions, optimize reimbursement outcomes, and maintain compliance with federal and state regulations.
Schedule: Full-time in office in Louisville, Kentucky
Compensation:Range $60k-$70k annually (salaried)
ADR Management
- Monitor, track, and manage ADRs from RACs, MACs, and Managed Care payers
- Coordinate with facility teams to gather complete and accurate medical records
- Submit ADR responses within required timelines and track confirmation/processing
- Review audit determinations and manage appeals when necessary
Claims Review & Follow-Up
- Review claims for accuracy and compliance with payer requirements
- Address denials, underpayments, and claim discrepancies
- Collaborate with internal teams to resolve outstanding claims and audit outcomes
Communication & Coordination
- Act as the primary liaison between corporate leadership and SNF/LTC facilities
- Provide guidance on ADR responses, appeals, and claims processes
- Communicate with auditors, payers, and insurance entities regarding reviews
Compliance & Documentation
- Ensure all submissions meet regulatory and payer standards
- Maintain detailed records of ADRs, appeals, and correspondence
- Support internal and external audits related to billing and documentation
Training & Education
- Train facility staff on ADR processes, documentation standards, and audit readiness
- Stay current on CMS, RAC/MAC, and Managed Care updates and share insights
QualificationsRequired Experience
- Minimum 3 years of experience in SNF healthcare reimbursement
- LPN licensed
- Hands-on experience with ADRs, RAC/MAC audits, or Managed Care claims
- Strong knowledge of Medicare, Medicaid, and Managed Care regulations
Technical Skills
- Proficiency in Microsoft Office (Excel, Word, Outlook)
- Experience with data tracking, reporting, and basic analysis in Excel
- Ability to learn and navigate EHR systems and medical record software
Additional Requirements- Strong attention to detail and organizational skills
- Ability to manage multiple deadlines in a fast-paced environment
- Knowledge of HIPAA compliance and healthcare privacy standards
- Willingness to work extended hours or occasional weekends as needed
Why Join Volare Health?- Opportunity to work with a collaborative and mission-driven healthcare team
- Direct impact on compliance, reimbursement accuracy, and patient care support
- Professional growth in a specialized and high-demand area of healthcare
This is a confidential search for an experienced reimbursement professional looking to make an impact within a collaborative and compliance-focused healthcare environment.