Operations Specialist
- Supports operations team with discovery and training as necessary with AdaptHealth processes.
- Responsible for providing support during process improvement initiatives to assist with driving all areas of workflow, including verification, and data analysis.
- Develop and maintain working knowledge of current products and services offered by the company
- Must be familiar with payer guidelines and reading clinical documentation to determine qualification status and compliance for all equipment and services.
- Working knowledge in all areas of AdaptHealth customer service, intake, daily operations and revenue cycle processes and workflows from beginning to end, which may include
- Review all required documentation to ensure accuracy
- Accurately process, verify, and/or submit documentation
- Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles
- Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required (if helping a region)
- Navigate through multiple online EMR systems to obtain applicable documentation
- Enter and review all pertinent information in EMR system including authorizations and expiration dates
- Meet quality assurance requirements and other key performance metrics
- Pays attention to detail and has great organizational skills
- Actively listens to teams, region leaders and handle stressful situations with compassion and empathy.
- Ability to analyze data and reports to identify execution errors in workflow, troubleshoot and fix the exceptions, advise staff on corrections.
- Collaborate with the Operations Team on exceptions and solutions within workflow processes
- Communicate with operations teams and leadership on an on-going basis regarding any noticed trends in process errors with insurance companies
- Assist with various projects and tasks as needed for various unique processes
- Participate in the effort to define, document, and refine processes, procedures and workflows for business operations based on industry and company best-practices.
- Participate in the effort to create training materials and train client engagement and service teams
- Maintain patient confidentiality and function within the guidelines of HIPAA.
- Completes assigned compliance training and other educational programs as required.
- Maintains compliant with AdaptHealth’s Compliance Program.
- Perform other related duties as assigned.
- Excellent ability to communicate both verbally and in writing
- Ability to prioritize and manage multiple tasks
- Proficient computer skills and knowledge of Microsoft Office
- Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction
- General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
- Work well independently and as part of a group
- Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team
- High School Diploma or equivalency
- Three (3) years’ work related in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry is required.
- Work environment will be stressful at times, as overall office activities and work levels fluctuate
- Must be able to bend, stoop, stretch, stand, and sit for extended periods of time
- Subject to long periods of sitting and exposure to computer screen
- Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use
- Excellent ability to communicate both verbally and in writing
- Ability to effectively communicate both verbally and written with internal and external customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy.
- Mental alertness to perform the essential functions of position.
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