Intake - Insurance Verification Specialist

Intake Specialist Opportunity

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 apply.

Job Duties :

• Enters referrals within allotted timeframe as established; meeting productivity and quality standards as established.
• Communicates with referral sources, physician, or associated staff to ensure documentation is routed to appropriate physician for signature / completion.
• Accurately enters referrals into appropriate system based on the type of referral obtained.
• Works with local branch leadership to ensure appropriate inventory / services are provided.
• Assists with other regional team functions, as necessary.
• For non-Medicaid patients communicates with patients their financial responsibility, collects payment and documents in patient record accordingly.
• Follows company philosophies and procedures to ensure appropriate shipping method utilized for delivery of service.
• Answers phone calls in a timely manner and assists caller.
• For non-Medicaid patients communicates with patients Responsible for reviewing medical records for non-sales assisted referrals to ensure compliance standards are met prior to a service being rendered.
• Must be an expert at payer guidelines and reading clinical documentation to determine qualification status and compliance for all equipment and services.
• Responsible for working with community referral sources to obtain compliant documentation in a timely manner to facilitate the referral process.
• Responsible for contacting patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
• Works with sales team to obtain necessary documentation to facilitate referral process as well as support referral source relationships.
• Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
• Works with verification team to ensure all needs are met for both teams to provide accurate information to the patient and ensure payments.
• Develop and maintain working knowledge of current products and services offered by the company.
• Review all required documentation to ensure accuracy.
• Maintains an extensive knowledge of different types of payer coverage and insurance policies.
• Responsible for verifying patient insurance coverage, to ensure necessary procedures are covered by the individuals insurance accurately.
• Complete insurance verification to determine patients eligibility, coverage, co-insurances, and deductibles.
• Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required.
• Resolves any issues with coverage and escalates complicated issues to a Manager.
• Completes accurate patient demographic and insurance entry into EMR databases.
• Responsible for entering data in an accurate manner, into EMR databases. To include payer, authorization requirements and coverage limitations and expiration dates as needed.
• Position requires staff to spend extensive amounts of time on the phone or on payer websites with insurance companies.
• Position requires representative to provide pertinent information regarding patients coverage.
• Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
• Communicate with Customer Service and Management on an on-going basis regarding any noticed trends with insurance companies.
• Verify insurance carriers are listed in the companys database system, if not request the new carrier is entered.
• Responsible for contacting patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
• Meet quality assurance requirements and other key performance metrics.
• Facilitate resolution on customer complaints and problem solving.
• Pays attention to detail and has great organizational skills.
• Actively listen to patients and handle stressful situations with compassion and empathy.
• Flexible with the actual work and the hours of operation.
• Utilize company provided tools to maintain quality. Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and How-To documents.

Competency, Skills and Abilities :

Requirements :

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individuals 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.