Job Details

Overview

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

Responsibilities

• Supports operations team with discovery and training as necessary with AdaptHealth processes.
• Provides support during process improvement initiatives to assist with driving all areas of workflow, including verification and data analysis.
• Develops and maintains working knowledge of current products and services offered by the company.
• Is familiar with payer guidelines and reading clinical documentation to determine qualification status and compliance for all equipment and services.
• Demonstrates 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 reviewing all required documentation to ensure accuracy, processing, verifying, and/or submitting documentation.
• Completes insurance verification to determine patient eligibility, coverage, co-insurances, and deductibles.
• Obtains pre-authorization if required by an insurance carrier and processes physician orders to insurance carriers for approval and authorization when required (if helping a region).
• Navigates through multiple online EMR systems to obtain applicable documentation.
• Enters and reviews all pertinent information in the EMR system including authorizations and expiration dates.
• Meets quality assurance requirements and other key performance metrics.
• Pays attention to detail and has strong organizational skills.
• Actively listens to teams, region leaders and handles stressful situations with compassion and empathy.
• Analyzes data and reports to identify execution errors in workflow, troubleshoots and fixes exceptions, and advises staff on corrections.
• Collaborates with the Operations Team on exceptions and solutions within workflow processes.
• Communicates with operations teams and leadership on an ongoing basis regarding trends in process errors with insurance companies.
• Assists with various projects and tasks as needed for various unique processes.
• Participates in defining, documenting, and refining processes, procedures and workflows for business operations based on industry and company best-practices.
• Participates in creating training materials and training client engagement and service teams.
• Maintains patient confidentiality and functions within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliance with AdaptHealths Compliance Program.
• Performs 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 the 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 team
• 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 experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry

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 in writing with internal and external customers with empathy, compassion, courtesy, and respect for privacy
• Mental alertness to perform the essential functions of the position