Operations Specialist Non-Driving

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 companyMust 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 includeReview all required documentation to ensure accuracyAccurately process, verify, and/or submit documentationComplete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductiblesObtain 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 documentationEnter and review all pertinent information in EMR system including authorizations and expiration datesMeet quality assurance requirements and other key performance metricsPays attention to detail and has great organizational skillsActively 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 processesCommunicate with operations teams and leadership on an on-going basis regarding any noticed trends in process errors with insurance companiesAssist with various projects and tasks as needed for various unique processesParticipate 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 teamsMust 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 resolutionLead team meetings and facilitate training sessions for staff developmentMonitor team performance metrics and productivity standards, providing feedback and coaching as neededServe as primary escalation point for difficult customer issues and complex regulatory compliance questionsDevelop and implement process improvements and workflow optimization strategiesCoordinate with management on staffing needs, scheduling, and resource allocationConduct new employee onboarding and ongoing training programsMaintain advanced expertise in Medicare guidelines, payer policies, and regulatory changes to guide team decisionsPrepare reports and analysis on team performance, trends, and operational metrics for management reviewMaintains 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 writingAbility to prioritize and manage multiple tasksProficient computer skills and knowledge of Microsoft OfficeSolid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interactionGeneral knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.Work well independently and as part of a groupAbility 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 preferredRelated 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) servicesSpecialist 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 fluctuateMust be able to bend, stoop, stretch, stand, and sit for extended periods of timeSubject to long periods of sitting and exposure to computer screenAbility to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer useAbility 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.