Operations Specialist

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

1. Review all required documentation to ensure accuracy
2. Accurately process, verify, and/or submit documentation 
3. Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles
4. 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)
5. Navigate through multiple online EMR systems to obtain applicable documentation
6. Enter and review all pertinent information in EMR system including authorizations and expiration dates
7. 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.