Fraud investigator Jobs in Coral Springs, FL

Job Type

Full-time

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.

Customer Service Specialist

Customer Service Specialists are responsible for learning and understanding the entire front-end process to ensure successful service for our patients. The Customer Service Specialists works in a fast-paced environment answering inbound calls and making outbound calls. Maybe responsible for obtaining, analyze, and verify the accuracy of information received from referrals, create orders, and or schedule the patient to receive equipment as ordered by their doctor. Customer Service Specialists should educate Patients of their financial responsibility when applicable.

Job Duties :

• Develop and maintain working knowledge of current products and services offered by the company
• Answer all calls and emails in a timely manner, in adherence to their goals
• Document all call information according to standard operating procedures
• Answer questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs
• Process orders, route calls to appropriate resource, and follow up on customer calls where necessary
• Review all required documentation to ensure accuracy
• Accurately process, verify, and / or submit documentation and orders
• Complete insurance verification to determine patient's 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
• Must be able to navigate through multiple online EMR systems to obtain applicable documentation
• Enter and review all pertinent information in EMR system including authorizations and expiration dates
• 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 company's 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 listens 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

Minimum Job Qualifications :

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.