Operations Specialist - Customer Service

Operations Specialist - Customer Service

The Operations Specialist is responsible for supporting the Operations Team through multiple tasks required for the successful support of each region’s individual needs.

Full-time

$19–$24 per hour, DOE

• 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 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 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 for approval and authorization when required.
• Navigates 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 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 workflow errors, 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 trends in process errors with insurance companies.
• Assists with various projects and tasks as needed for unique processes.
• Participates in defining, documenting, and refining processes, procedures and workflows for business operations based on industry and company best‑practices.
• Creates training materials and trains client engagement and service teams.
• Maintains patient confidentiality and complies with HIPAA guidelines.
• 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 verbal and written communication skills.
• Ability to prioritize and manage multiple tasks.
• Proficient computer skills and knowledge of Microsoft Office.
• Ability to learn new technologies and understand data flow through systems.
• General knowledge of Medicare, Medicaid, and commercial health plan methodologies and documentation requirements preferred.
• Works well independently and as part of a group.
• Adaptable and flexible in a rapidly changing environment; patient, accountable, proactive, takes initiative, and works effectively on a team.

Education and Experience Requirements:

• High School Diploma or equivalency.
• Three (3) years’ work experience in health‑care administration, financial or insurance customer services, claims, billing, call center or management, regardless of industry.

• Work environment can be stressful at times; activity and workload fluctuate.
• Must be able to bend, stoop, stretch, stand, and sit for extended periods.
• Subject to long periods of sitting and computer screen exposure.
• Ability to perform repetitive wrist, hand, or finger motions due to extensive computer use.
• Excellent communication skills (verbal and written); demonstrates empathy, compassion, courtesy, and respect for privacy.
• Mental alertness to perform essential functions.

Mid–Senior level

Full-time

Management

Industry: Hospitals and Health Care