Lead, Insurance Verification Specialist

AdaptHealth•Beaver, PA

About The Position

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. Lead, Insurance Verification Specialist Lead Insurance Verification Specialists are the subject matter expert and will be responsible for assisting leadership with oversight of the team. This individual will provide feedback, training, and guidance to ensure staff is following department protocol with processes. The Lead will handle escalated phone calls from patients or insurance companies that cannot be effectively resolved by staff. This individual will work closely with supervisor and Leadership to develop process improvements. responsible for learning and understanding the entire front-end process to ensure successful service for our patients. 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.

Requirements

High School Diploma required; Associated degree preferred.
Three (3) years’ work related in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry required.
Two (2) HME claims experience is preferred.
Exact job experience is considered any of the above tasks in a Medicare certified HME, IV or HH environment that routinely bills insurance.
Excellent customer service skills
Analytical and problem-solving skills with attention to detail
Decision Making
Excellent ability to communicate both verbally and in writing.
Ability to prioritize and manage multiple tasks.
Proficient computer skills and knowledge of Microsoft Office
Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
Work well independently and as part of a group.
Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team.

Responsibilities

Mentors, guides and provide oversight assistance of the team.
Applying subject expertise in evaluating business operations and processes.
Identifying areas where technical solutions would improve business performance.
Consulting across teams, providing mentorship, and contributing specialized knowledge.
Demonstrated various techniques and documentation to streamline production process.
Identify team member strengths and opportunities and report findings up to supervisors.
Respond to internal inquiries for coaching assistance via the subject matter expert queue, office communicator, and email.
Assume responsibility for resolving team member escalations by working with multiple business partners while consistent communication is present with the member.
Coach others on how to navigate through systems to find information needed for patients and calls.
As a Subject Matter Expert, assist with training new employees and assist others with problems they encountered while interacting with members over the phone; addressed escalated customer questions and concerns.
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 individual’s insurance accurately.
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.
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 patient’s 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 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