Intake Specialist
- Accurately enters referrals within allotted timeframe as established; meeting productivity and quality standards as established.
- Communicates with referral sources, physician, or associated staff to ensure documentation is routed to appropriate physician for signature/completion.
- Works with leadership to ensure appropriate inventory/services are provided.
- Communicates with patients regarding their financial responsibility, collects payment and documents in patient record accordingly.
- For non-Medicaid patients communicate with patients
- Responsible for reviewing medical records for non-sales assisted referrals to ensure compliance standards are met prior to a service being rendered.
- Follows company philosophies and procedures to ensure appropriate shipping method utilized for delivery of service.
- Answers phone calls in a timely manner and assists caller.
- Reviews medical records for non-sales assisted referrals to ensure compliance standards are met prior to a service being rendered.
- Demonstrates expert knowledge of payer guidelines and reads clinical documentation to determine qualification status and compliance for all equipment and services.
- Works with community referral sources to obtain compliant documentation in a timely manner to facilitate the referral process.
- Contacts patients when documentation received does not meet payer guidelines, provide updates, and offer additional options to facilitate the referral process.
- Works with sales team to obtain necessary documentation to facilitate referral process, as well as support referral source relationships.
- Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
- Works with insurance verification team to ensure all needs are met for both teams to provide accurate information to the patient and ensure payments.
- Assume on-call responsibilities during non-business hours in accordance with company policy.
- Lead Responsibilities:
- Supervise and provide guidance to team members in daily operations and complex case resolution
- Lead team meetings and facilitate training sessions for staff development
- Monitor team performance metrics and productivity standards, providing feedback and coaching as needed
- Serve as primary escalation point for difficult customer issues and complex regulatory compliance questions
- Develop and implement process improvements and workflow optimization strategies
- Coordinate with management on staffing needs, scheduling, and resource allocation
- Conduct new employee onboarding and ongoing training programs
- Maintain advanced expertise in Medicare guidelines, payer policies, and regulatory changes to guide team decisions
- Prepare reports and analysis on team performance, trends, and operational metrics for management review
- Maintains patient confidentiality and functions within the guidelines of HIPAA.
- Completes assigned compliance training and other education programs as required.
- Maintains compliance with AdaptHealth's Compliance Program.
- Performs other related duties as assigned.
- Ability to appropriately interact with patients, referral sources and staff.
- Decision Making.
- Analytical and problem-solving skills with attention to detail.
- Strong verbal and written communication.
- Excellent customer service and telephone service skills.
- Proficient computer skills and knowledge of Microsoft Office.
- Ability to prioritize and manage multiple tasks.
- Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
- Ability to work independently as well as follow detailed directives
- Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
- High school diploma or equivalent required; Associate’s degree in healthcare administration, Business Administration, or related field preferred
- Related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
- Exact job experience is health care organization, pharmacy that routinely bills insurance or provides Diabetics, Medical Supplies, HME, Pharmacy or healthcare (Medicare certified) services
- Specialist Level: (Entry Level):
- Senior Level:
- Lead Level:
- Extended sitting at computer workstations with repetitive keyboard use; occasional standing, bending, and lifting to 10 pounds.
- Professional office setting with variable stress levels during authorization deadlines, appeals processes, and urgent patient authorization needs.
- Proficiency with computers, office equipment, payer portal systems, and healthcare software applications
- Sustained concentration, diligence, and ability to manage confidential patient and insurance information with discretion.
- Communication: Professional verbal and written communication skills for payer interactions and healthcare provider coordination at all organizational levels
- Ability to work independently with minimal supervision and availability for extended hours when required.
- Mental alertness to perform the essential functions of position.
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