Operations Specialist

Operations Specialist

The Operations Specialist is responsible for supporting the Operations Team through multiple tasks required for the successful support of each region's individual needs. As needed, may need to deliver and set up medical equipment. 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

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
• 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.
• As needed, perform patient assessment and re-assessment for patient care, deliver medical equipment.
• Safely drive as needed and maintain company vehicle.
• Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.
• 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
• Valid and unrestricted driver's license in the state of residence.
• 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 plus
• Two (2) years exact job experience
• Lead Level:
• One (1) year of work-related experience plus
• Four (4) years exact job experience

Physical Demands and Work Environment

• Must be able to regularly lift and/or move up to 50 pounds, frequently lift and/or move up to 100 pounds, and occasionally lift and/or move up to 160 pounds.
• Must be able to stretch, bend, stoop and crouch and perform moderate to heavy physical labor while moving equipment and supplies.
• Subject to long periods of sitting and/or driving.
• Work environment may be stressful at times, as overall work activities and work levels fluctuate.
• May be exposed to unsanitary conditions in some home settings.
• May be exposed to hazardous materials, loud noise, extreme heat/cold, direct, or indirect contact with airborne, bloodborne, and/or other potentially infectious pathogen.
• May be exposed to high crime areas within the service community.
• Must be able to drive independently and travel as needed.
• May be exposed to angry or irate customers.
• Must be able to access the patient's residence without assistance.
• Ability to effectively communicate both verbally and written with customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy.