Customer Service Specialist

AdaptHealth, LLC•Charlotte, NC

12d

About The Position

Customer Service Specialists learn and manage the front-end process to ensure successful service for patients. They work in a fast-paced environment answering inbound calls and making outbound calls. The role may include obtaining, analyzing, and verifying referral information, creating orders, scheduling patients to receive doctor-ordered equipment, and educating patients about their financial responsibility when applicable. Specialists answer customer questions, process and follow up on orders and calls, review and submit documentation, verify insurance eligibility and coverage, and obtain required pre-authorizations. They use multiple online EMR systems and company-provided tools, communicate trends to Customer Service and Management, and help resolve customer complaints while meeting quality assurance requirements and performance metrics. The role requires attention to detail, organization, compassion, flexibility, and the ability to manage multiple tasks in a changing environment.

Requirements

High school diploma or equivalent.
At least one year of work-related experience in healthcare administrative, financial, or insurance customer service, claims, billing, call center, or management, regardless of industry.
Excellent customer service skills.
Analytical and problem-solving skills with attention to detail.
Decision-making ability.
Excellent verbal and written communication skills.
Ability to prioritize and manage multiple tasks.
Proficient computer skills and knowledge of Microsoft Office.
Ability to learn new technologies and technical aptitude to understand data flow and system interactions.
Ability to work independently and as part of a group.
Ability to adapt and be flexible in a rapidly changing environment, demonstrate patience and accountability, take initiative, and work effectively on a team.
Senior-level qualification: two years of work-related experience and one year of exact job experience. Exact job experience is defined as any of the listed tasks in a Medicare-certified setting.

Nice To Haves

General knowledge of Medicare, Medicaid, and commercial health plan methodologies and documentation requirements.

Responsibilities

Develop and maintain working knowledge of the company’s current products and services.
Answer calls and emails promptly in accordance with performance goals, and document call information according to standard procedures.
Answer questions about products, services, retail stores, service lines, and other relevant information.
Process orders, route calls to appropriate resources, and follow up with customers when necessary.
Review required documentation for accuracy and accurately process, verify, and submit documentation and orders.
Verify insurance eligibility, coverage, co-insurance, and deductibles.
Obtain required pre-authorizations and submit physician orders to insurance carriers for approval and authorization when required.
Navigate multiple online EMR systems to obtain documentation and enter and review pertinent information, including authorizations and expiration dates.
Communicate observed insurance-company trends to Customer Service and Management.
Verify that insurance carriers are listed in the company database and request that new carriers be added when needed.
Contact patients when received documentation does not meet payer guidelines, provide updates, and offer options to facilitate the referral process.
Meet quality assurance requirements and other key performance metrics.
Help resolve customer complaints and problems.
Use company-provided tools, which may include Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI, PECOS, and how-to documents.
Educate patients about their financial responsibility when applicable.