Document Review Specialist

Position Summary: 

The Document Review Specialist is responsible for reviewing delivery/shipping tickets documentation and on-site orders 

to ensure AdaptHealth is meeting compliance standards according to payer regulations/guidelines prior to releasing the 

on-hold delivery ticket in our billing system. Their review will include, but not limited to, things such as proof of delivery, 

qualifying documentation, logging CMN’s, standards and accuracy of CMS or managed care payer billing guidelines. 

The Document Review Specialist will be responsible for reviewing all delivery/shipping tickets on-hold, initial CMN’s and 

initial Pars as received from the regions after confirmation. 

Essential Functions and Job Responsibilities: 

? Develop and maintain working knowledge of current HME products and services offered by the company. 

? Review and manage patient eligibility documents such as prescriptions, certificates of medical necessity, letters of 

medical necessity and prior authorizations. 

? Analyze documentation required for billing services and ensure compliance to payer requirements 

? Review’s documentation to make sure it is valid prior to releasing to bill claims in order to ensure completeness 

and accuracy. 

? Through daily work activities identifies trends, either system or process driven, that can be changed or modified to 

improve efficiency and create cost savings 

? Accurately process, verify, and/or approve documentation to facilitate the release of claims to bill. 

? Complete insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles 

? Must be able to navigate through multiple online EMR systems to obtain and or review applicable documentation

? Review and log all pertinent information in EMR system including initial authorizations, initial CMN and expiration 

dates 

? Collaborates with AdaptHealth sales and support staff to ensure timely receipt of documentation. 

? Communicate with leadership on an on-going basis regarding any noticed trends with insurance companies 

? Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered 

? Meet quality assurance requirements and other key performance metrics 

? Maintain and review all required documentation for insurance coverage and reimbursement per insurance 

guidelines and company policy. 

? Contact AdaptHealth operations teams, and centralized RCM teams, to obtain additional supporting medical 

necessity documents if warranted. 

? Report to supervisor any apparent issues and coordinate submission of all required documentation. 

? Assist with implementation of performance improvement program as it relates to billing and coding performance. 

? Maintain patient confidentiality and function within the guidelines of HIPAA. 

? Develop and maintain working knowledge of current HME products and services offered by the company. 

? Completes assigned compliance training and other educational programs as required. 

? Maintains compliant with AdaptHealth’s Compliance Program. 

? Perform other related duties as assigned. 

? 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. 

? Maintain patient confidentiality and function within the guidelines of HIPAA. 

? Completes assigned compliance training and other educational programs as required. 

? Maintains compliant with AdaptHealth’s Compliance Program. 

? Perform other related duties as assigned. 

Competency, Skills and Abilities: 

? Knowledge of Medicare, Medicaid, and commercial health plan reimbursement methodologies and documentation 

requirements. 

? Excellent verbal and written communication skills. 

? Well organized, detail oriented and possess strong problem-solving and critical thinking skills. 

? Ability to prioritize tasks, manage multiple projects and work independently 

? Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative 

and work effectively on a team. 

? Ability to read and interpret documents such as Medicare, Medicaid and commercial health plan policy articles 

and procedure manuals. 

? Ability to prepare routine reports and correspondence. 

? Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. 

Ability to deal with problems involving several concrete variables in standardized situations. 

? Computer Skills: Strong proficiency in Microsoft Office: Excel, Word, Outlook 

Education and Experience Requirements: 

? 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. 

Physical Demands and Work Environment:

? Work environment may 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.

? Must be able to lift 5 to 10 pounds periodically as needed.

? Ability to utilize a personal computer and other office equipment.

? May be exposed to angry or irate customers.

? Ability to work independently with little or no supervision.

? Mental alertness to perform the essential functions of position.