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Medicare Operations Specialist - Home Health and Hospice

Toledo, Ohio 000 - ProMedica Senior Care Corporate Office
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ProMedica is a mission-based, not-for-profit health and well-being organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 45,000 employees, 11 hospitals, 2,100+ physicians and advanced practice providers with privileges, 1,000+ healthcare providers employed by ProMedica Physicians, a health plan, and senior care services.

ProMedica`s senior care division operates 330+ assisted living facilities, skilled nursing centers, memory care communities and hospice, palliative and home health care agencies. Services are provided in 26 states and the majority now operate under the ProMedica brand and Arden Courts. Over the next few months, the rest of our entities under the Heartland and ManorCare names will rebrand to ProMedica.

Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address and lead in social determinants of health, champion healthy aging and cultivate innovative solutions. For more information about ProMedica senior care services, please visit


The Medicare Operations Specialist is responsible for working with facilities in ensuring that correct documentation has been completed and submitted to fiscal intermediaries for appropriate reimbursement for services provided.


  • Provides assistance to Home Health & Hospice agencies in the execution of Program Integrity and Medical Review Audits and appeals. (e.g., UPIC, SMRC, ADR, TPE, RCD, CERT, RAC, PERM, etc.)
  • Monitors and tracks external audits for Home Health & Hospice agencies to include submission of records, results of audits, and appeals.
  • Consistently reviews and evaluates the quality of overall patient care documentation of Home Health and Hospice agencies.
  • Stays abreast of developments in Program Integrity and Medicare Conditions of Participation that impact medical review.
  • Provides education to Home Health and Hospice agencies regarding Program Integrity and Medical Review Audits and appeals.
  • Attends operations meetings as requested.

Be a part of the team leading the nation in healthcare!



Educational Requirements

RN required. Hospice certification preferred.

Position Requirements

Minimum of 3 years experience in providing hospice nursing. Previous management or supervisory experience in home health or hospice agency. 

Job Specific Details:


  • Education - Registered Nurse required. BSN preferred.
  • Experience - Five or more years of previous Home Health and Hospice experience in Medicare reimbursement.
  • Approximately 25% travel requirement.


Nursing - Management

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ProMedica Copyright © 2021 ProMedica Senior Care USA, Inc.
All Rights Reserved.

*Equal Opportunity Employer*

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