Job Details

DescriptionPosition 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 teamRequirementsEducation 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* Senior Level:One (1) year of work-related experience plusTwo (2) years exact job experience* Lead Level:One (1) year of work-related experience plusFour (4) years exact job experiencePhysical 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.