The ADR and Appeals Manager will lead the management of the Additional Documentation Request and appeals process at Ciena Healthcare, ensuring compliance with regulatory standards while collaborating with various teams. This role is pivotal in supporting timely and accurate responses to audits and denials, making a significant impact on the organization’s operational success.
Key Responsibilities
Oversee the ADR and appeals process for Ciena Healthcare
Ensure compliance with Medicare and Medicaid requirements
Manage and track ADRs from payers
Coordinate with third-party vendors for documentation submission
Draft, review, and submit appeals
Conduct root cause analysis of denials
Train teams on documentation best practices
Maintain tracking systems for ADR and appeal status
Required Qualifications
Bachelor’s degree in health information management, Nursing, Healthcare Administration, or related field
3–5 years of experience in healthcare reimbursement, appeals, or compliance
Strong knowledge of MDS 3.0, PDPM, Medicare/Medicaid regulations
Ability to manage multiple deadlines and coordinate cross-functional teams
Proficiency in Microsoft Office Suite
Experience with EHR and billing systems
Preferred Qualifications
RHIA, RHIT, RN, or equivalent
Familiarity with MACs, RACs, UPICs, and ZPICs
Benefits & Perks
Competitive payMedical, dental, and vision insurance401K with matching fundsLife InsuranceEmployee discountsTuition ReimbursementStudent Loan Reimbursement