Job Details

Description

Position Summary:

The Operations Specialist is responsible for supporting the Operations Team through multiple tasks required for the successful support of each region's individual needs.

Essential Functions and Job Responsibilities:

* 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.

Competency, Skills and Abilities:

* 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

Requirements

Education and Experience Requirements:

* 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.

Physical Demands and Work Environment:

* 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.