Operations Specialist

Position Summary

The Operations Specialist at Adapt Health supports the Operations Team across regions, handling workflow tasks, process improvement, documentation review, insurance verification, and compliance.

• Supports operations team with discovery and training as necessary with Adapt Health processes.
• Provides support during process improvement initiatives to assist with driving all areas of workflow, including verification and data analysis.
• Develops and maintains working knowledge of current products and services offered by the company.
• Familiar with payer guidelines and reads clinical documentation to determine qualification status and compliance for all equipment and services.
• Has working knowledge in all areas of Adapt Health customer service, intake, daily operations, and revenue cycle processes and workflows from beginning to end.
• Reviews all required documentation to ensure accuracy.
• Accurately processes, verifies, and/or submits documentation.
• Completes insurance verification to determine patient’s eligibility, coverage, co‑insurances, and deductibles.
• Obtains pre‑authorization if required by an insurance carrier and processes physician orders to insurance carriers for approval and authorization when required.
• Navigates through multiple online EMR systems to obtain applicable documentation.
• Enters and reviews all pertinent information in EMR system including authorizations and expiration dates.
• Meets quality assurance requirements and other key performance metrics.
• Pays attention to detail and has great organizational skills.
• Actively listens to teams, region leaders and handles stressful situations with compassion and empathy.
• Analyzes data and reports to identify execution errors in workflow, troubleshoots and fixes exceptions, and advises staff on corrections.
• Collaborates with the Operations Team on exceptions and solutions within workflow processes.
• Communicates with operations teams and leadership on an ongoing basis regarding any noticed trends in process errors with insurance companies.
• Assists with various projects and tasks as needed for various unique processes.
• Participates in the effort to define, document, and refine processes, procedures and workflows for business operations based on industry and company best‑practices.
• Participates in the effort to create training materials and trains client engagement and service teams.
• Maintains patient confidentiality and functions within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliance with Adapt Health’s Compliance Program.
• Performs other related duties as assigned.

• Excellent communication, both verbal and written.
• 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.
• Works 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.

Education:

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.

• 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 verbal and written communication skills.
• Ability to effectively communicate both verbally and written with internal and external customers, demonstrating empathy, compassion, courtesy, and respect for privacy.
• Mental alertness to perform the essential functions of the position.

Mid-Senior level

Full-time

Management and Manufacturing

Hospitals and Health Care