Healthcare Documentation Associate

Overview

Adapt Health is a premier full-service home medical equipment company in the United States – offering a full-scope of cost-efficient HME and respiratory care products and services that aim to keep patients comfortable and thriving in their own homes. We are dedicated to pursuing better outcomes by using technology, process and the power of our national network. We have a relentless commitment to using innovation to transform the durable medical equipment industry, break the status quo and provide the best quality care.

The RCM Specialist (Healthcare Documentation Specialist) is responsible for maintaining a timely revenue cycle for all goods and services provided by Adapt Health. Also responsible for maintaining patient confidentiality and functioning within the guidelines of HIPAA. Completes assigned compliance training and other educational programs as required. Maintains compliance with Adapt Health’s Compliance Program.

• Account Receivable
• Ensure organization receives accurate payment for goods & services provided according to contracted rates and/or payer fee schedules.
• Collect on accounts by sending bills or following up on bills with payers via phone, email, fax, mail, or websites.
• Reconcile the accounts receivable to ensure that all payments are accounted for and properly posted.
• Investigate and resolve customer inquiries regarding charges.
• Monitor patient account details for non-payments, delayed payments, and other irregularities.
• Communicate with customers regarding insurance, payments, and invoices.
• Research and resolve payment discrepancies.
• Identify and verify that billing complies with policies and procedures.
• Identify trends and root causes related to inaccurate payments and escalate as appropriate.

• Authorization
• Analyze daily requests to determine coverage and approval utilizing criteria.
• Utilize clinical staff for medical reviews when necessary.
• Notify staff when authorization is approved or denied.
• Obtain and enter authorization into database timely and accurately.
• Collaborates with internal & external customers to provide status updates & coordinate appeals on denied authorization.
• Resolves pending revenue by reconciling approved authorizations and pending charges.

• Confirmation
• Ensure order will bill correctly to insurance.
• Ensure order has valid proof of delivery.
• Address messages on sales order
• Correct messages as needed.
• Process order to correct WIP state or confirm order.

• Data Support
• Responsible for the daily claims submissions/printing for all eligible/ready status claims
• Resolves all claim rejections in a timely manner to guarantee submission within the timely filing requirements of the payers.
• Identifies claim rejections and escalates as appropriate to facilitate educational opportunities or process improvements.
• Maintains daily, weekly, monthly system/database functions and performs routine functions as defined by leadership.

• Unbilled Revenue
• Analyze documentation required for billing services and ensure compliance to payer requirements.
• Resolve pending revenue by reconciling received documentation and pending charges.
• Requests authorization from state Medicaid programs.
• Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices.
• Completes accurate documentation of authorization request and follow up activities on each account.
• Ensures proper payer and system follow up procedures are performed for accurate authorization tracking.
• Performs extensive account audits and ensures proper billing for services to the accurate payer.
• Ensures proper revenue recognition for billed charges and services moving forward.
• Completes all assigned requalification within the set 75-day time frame by having patients retested, picking up equipment when appropriate, or executing ABNs and setting patients up on autopay.
• Investigate and resolve customer, patient, or physician office concerns regarding questions while working with the patient through the requalification process.
• Establish and maintain relationships with key individuals in the regions to support the requalification…