RN / Home Healthcare Nursing Job in Dallas, Texas / Government
Company: Kindred at Home
Posted on: August 4, 2022
This position is a remote position. It can be located anywhere
in the U.S.
Responsible to respond to, monitor and analyze all governmental
requests, including but not limited to Additional Development
Requests (ADRs), CERTS, Recovery Audit Contractors (RACs), Zone
Program Integrity Contractors (ZPICs), Supplement Medicare Recovery
Contractors (SMERCs), Unified Program Integrity Contractors (UPICs)
and all other revenue-driven denials and requests. Guides and
coordinates with the program staff in developing responses.
Identifies the need for changes in policies, procedures,
documentation strategies, and protocols based on regulatory
requirements and makes recommendations as indicated.
Responsible for responding to, managing and monitoring all payer
requests for additional documentation (ADR) and denials. Works with
program staff to gather required information and ensure timely
response to payer requests for additional documentation.
Monitors denials, collaborates with program and billing staff to
determine appropriate response, manages appeals process.
Monitors and responds to all requests related to revenue recovery
including but not limited to Government and private payer
Collaborates with program and billing department staff to develop
appropriate and timely responses.
Responsible for constructing response to denials and appeals,
utilizing any federal and state guidelines and local coverage
determination guidelines that are applicable to the record and
Monitors the development, interpretation and implementation of
federal and state governmental regulations. Coordinates the
dissemination of information to program management and regional
Provides trended reports for operations and clinical management in
order to improve performance, collaborates with and acts as a
resource for division and field support staff in identifying areas
in need of attention/improvement.
Identifies the need for new and revised policies and training based
on trends, changes in regulations, operations or clinical
Participates in project team activities, and serves as a backup to
Divisional regulatory staff on issues of regulations, coverage,
compliance and documentation.
Reviews records and operations as requested regarding compliance
with policy and payer requirements.
Responsible for assigned tasks within requests tracking system:
entering, tracking, uploading records, etc.
Participates in and provides training as assigned.
Current state license as a Registered Nurse.
Current drivers license. Must have reliable transportation and
5 years of professional experience in home health, 2 of which are
in an administrative, supervisory, or teaching position in or
related to a Medicare certified home health agency.
A thorough knowledge of federal regulations and Medicare
requirements is required along with analytical skills to interpret
and apply regulatory requirements.
Extensive knowledge of home health operations, compliance
requirements and legal issues in home health
Extensive experience in working with payer requirements, ADR
requests, Denials, Appeals, RAC, ZPIC, CERT, etc. responses
Excellent written and verbal communications skills.
Must be able to multi-task and work well under pressure.
Must be able to learn medical record and tracking systems quickly
Must be proactive, responsive and resourceful.
Highly flexible and motivated with an ability to work independently
as well as in a team setting.
Must consistently demonstrate the highest level of professionalism
Ability to work a flexible schedule and extended hours on occasion
in order to meet deadlines and/or work on special projects.
Requires working under some stress conditions to meet deadlines and
Keywords: Kindred at Home, Garland , RN / Home Healthcare Nursing Job in Dallas, Texas / Government, Healthcare , Garland, Texas
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