Description
Position Summary:
The Operations Specialist is a non-driving position responsible for supporting the Operations Team through multiple tasks required for the successful support of each region’s individual needs.
The lead specialist serves as a subject matter expert, conducts new hire training and mentor to the team.
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
- 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.
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 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):
One (1) year of work-related experience
One (1) year of work-related experience plus
Two (2) years exact job experience
One (1) year of work-related experience plus
Four (4) years exact job experience
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
- 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.
