Audit Specialist

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.

Position Summary:

Responsible for maintaining the process and timely response to billing compliance audits conducted by Medicare, Medicaid, and commercial health plans. Audit Coordinators will be responsible for analyzing health plan reimbursement policies for coverage and documentation requirements, patient file documentation for completeness and accuracy, documentation procurement and retrieval, and initiating and responding to inquiries from: AdaptHealth Account Executives, operations teams, and physicians regarding obtaining additional supporting medical necessity documentation.

 Essential Functions and Job Responsibilities: 

• Develop and maintain working knowledge of current HME products and services offered by the company.
• Maintain and review all required documentation for insurance coverage and reimbursement per insurance guidelines and company policy.
• Log and report all received audit inquiries: Prepayment audits/development letters; post payment requests for documentation; overpayment refund requests; medical necessity documentation and CERT audits; all other audit activity as assigned.
• Retrieve all documentation including, but not limited to proof of delivery, written orders, Certificates of Medical Necessity, clinical test results and/or studies, letters of medical necessity, medical record notes, signature attestations, Advanced Beneficiary Notices, etc.
• Contact AdaptHealth Account Executives, operations teams, and physicians, to obtain additional supporting medical necessity documents.
• Review all documentation to be submitted for audit purposes for completeness and accuracy.
• Report to supervisor any apparent issues and coordinate submission of all required documentation.
• Complete all required fields and notes in proprietary audit application.
• Scan and upload audit request, submission, correspondence, findings, and results.
• Assist with tracking and reporting of audit findings and results.
• Assist with implementation of performance improvement program as it relates to billing and coding performance.
• Maintain confidentiality of all audit projects and information.

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 speak effectively before groups of employees of the organization.
• Ability to calculate figures and amounts such as discounts, interest, proportions, and percentages. Ability to apply concepts of basic statistics.
• 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.

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.