Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Medicare Prior Authorization Clinical Documentation Cross-Functional Collaboration Data-Flow Analysis Medical Science Call Center Experience Billing Escalation Procedures Medical Record Management Continuous Quality Improvement (CQI) Clinical Database Development Insurance Follow-Up Clinical Documentation Enform Software Revenue Accounting Medication Inventory Online Communication Productivity Improvement

Other Skills

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Microsoft Office
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Customer Service
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Computer Literacy
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Decision Making
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Professionalism
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Non-Verbal Communication
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Adaptability
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Multitasking
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Teamwork
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Customer Service
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Analytical Thinking
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Detail Oriented
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Plan Execution
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Problem Solving

Roles & Responsibilities

High School Diploma or equivalent
At least 1 year of health care administrative, financial, or insurance customer service, claims, billing, call center, or management experience (2 years for senior level)
Experience in a Medicare-certified HME, diabetic, pharmacy, or home medical supplies environment that routinely bills insurance
Strong verbal and written communication skills with excellent customer service; proficient in Microsoft Office; ability to prioritize and manage multiple tasks

Requirements:

Create and generate electronic forms requesting patient documents from physicians and insurance providers; collect and manage patient eligibility documents (prescriptions, certificates of medical necessity, letters of medical necessity, and prior authorizations)
Contact physician offices and insurance companies to obtain prescriptions, certificates of medical necessity, letters of medical necessity, clinical notes, lab results, and approved prior-authorization requests
Ensure compliance with Medicare, Medicaid, HIPAA, and private insurance regulations; analyze documentation required for billing and ensure payer requirements; reconcile pending charges to resolve revenue
Collaborate with physician offices, AdaptHealth sales and support staff to ensure timely receipt of documentation; serve as backup to Customer Service for concerns or questions; monitor trends and provide education on compliant documentation

Job description

Description

AdaptHealth Opportunity – Apply Today!

At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives – out of the hospital and in their homes. We are actively recruiting in your area. If you are passionate about making a profound impact on the quality of patients’ lives, please click to apply, we would love to hear from you.

Documentation Specialist

Documentation Specialists creates and generates electronic forms requesting patient documents from physicians and insurances, as well as collect and manage patient eligibility documents. Additionally, responsible for maintaining a timely revenue cycle for all the goods and services provided by AdaptHealth.

Job Duties:

Create and generate electronic forms requesting patient documents from physicians.
Collect and manage patient eligibility documents such as prescriptions, certificates of medical necessity, letters of medical necessity and prior authorizations.
Contact doctor offices as necessary to collect prescriptions, certificates of medical necessity, letters of medical necessity, clinical notes, and lab results.
Contact insurance companies to collect approved prior-authorization requests.
Escalate recurring problem accounts or physician groups or other trends to the management appropriately and in a timely manner.
Maintain regular, predictable, consistent attendance and flexibility to meet the needs of the department.
Understand and follow all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements.
Plan and organize work effectively and ensure its completion.
Meet all productivity requirements.
Demonstrate team behavior and promote a team-oriented environment.
Actively participate in continuous quality improvement.
Always represent the organization professionally.
Serve as backup to Customer Service department for customer concerns, issues, complaints, or questions.
Analyze documentation required for billing services and ensure compliance to payer requirements.
Resolve pending revenue by reconciling received documentation and pending charges.
Collaborates with physician offices, AdaptHealth sales and support staff to ensure timely receipt of documentation.
Identify trends and providing feedback and education to internal and external customers on compliant documentation requirements for services provided.
Requests authorization from state Medicaid programs.
Maintains and updates physician databases to ensure accurate delivery of billing documentation and communications with physician offices.

Competency, Skills and Abilities:

Decision Making
Analytical and problem-solving skills with attention to detail
Strong verbal and written communication
Excellent customer service skills
Proficient computer skills and knowledge of Microsoft Office
Ability to prioritize and manage multiple tasks
Reports To: Department Manager Approved by: Human Resources
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction

Requirements

Minimum Job Qualifications:

High School Diploma or equivalent
One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry
Senior level requires two (2) years of work-related experience and one (1) year of exact job experience
Exact job experience is considered any of the above tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual’s race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.

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