permanent remote job- home health pre claim/adr reviewers

2 weeks ago

Work from Home, Philippines Cliniqon LLC Full time ₱350,000 - ₱700,000 per year

Are you detail-oriented and passionate about ensuring accuracy and compliance in healthcare documentation? We're looking for a dedicated Home Health Pre-Claim / ADR Reviewer to join our team, helping us deliver excellence in patient care and reimbursement processes.

As a Home Health Pre-Claim / ADR Reviewer, you will play a critical role in reviewing and processing pre-claim submissions and Additional Documentation Requests (ADRs). Your meticulous attention to clinical documentation and thorough knowledge of Medicare, Medicaid, and other payer requirements will ensure claims are accurate, complete, and compliant—supporting timely reimbursement and high-quality care delivery.

You will collaborate closely with clinical staff, stay ahead of regulatory updates, and help improve documentation standards across the board.

Responsibilities

  • Review pre-claim submissions for completeness and adherence to payer requirements.
  • Ensure clinical documentation accurately reflects patient conditions and care provided.
  • Provide clear, constructive feedback to clinical teams on documentation improvements.
  • Analyze ADRs to identify and gather necessary documentation for compliance.
  • Submit timely, accurate ADR responses to avoid reimbursement delays.
  • Stay informed of evolving home health regulations and payer policies.
  • Conduct regular audits to maintain compliance and quality standards.
  • Participate in ongoing training to enhance your regulatory and compliance expertise.
  • Collaborate effectively with clinical and billing teams to resolve documentation or claims issues.
  • Report regularly to management on pre-claim and ADR review status and trends.

Requirements:

  • Bachelor's degree in Nursing, Health Information Management, or a related field preferred.
  • Minimum 1 year experience in home health care, with a focus on documentation and compliance.
  • Solid knowledge of Medicare and Medicaid home health regulations.
  • Prior experience in pre-claim review or ADR processing is a strong plus.
  • Exceptional attention to detail and strong organizational skills.
  • Ability to interpret complex regulatory requirements accurately.
  • Proficiency with Electronic Health Records (EHR) and clinical documentation systems.
  • Excellent communication and interpersonal skills to work effectively with multidisciplinary teams.

Why Cliniqon?

  • Permanent work-from-home
  • Retention bonus
  • Performance bonus
  • Immense growth opportunities
  • Company-provided assets
  • HMO coverage
  • Many more benefits

Apply Now

Send your resume to

Ready to make an impact in home health care? Apply now and join a company that values your expertise and supports your professional growth

Job Type: Full-time

Benefits:

  • Health insurance
  • Life insurance
  • Opportunities for promotion
  • Paid training
  • Pay raise
  • Work from home

Application Question(s):

  • Do you have at least one year of experience in home health care documentation and compliance?
  • Are you familiar with Medicare and Medicaid regulations related to home health services?
  • Have you previously worked in a pre-claim review or Additional Documentation Request (ADR) processing role?
  • Are you proficient in using Electronic Health Records (EHR) systems?
  • Are you amenable to start ASAP?

Work Location: Remote

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