Quality Assurance Specialist

Adapthealth • Lynnwood, WA

254d • Remote

About The Position

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. The Quality Assurance Specialist is responsible for reviewing delivery/shipping tickets and on-site orders to ensure AdaptHealth is meeting compliance standards according to accreditation and payer regulations/guidelines prior to confirming the delivery ticket in our billing system. Their review will include, but not limited to, things such as proof of delivery standards and accuracy of CMS or managed care payer billing guidelines. The Quality Assurance Specialist will be responsible for confirming all delivery/shipping tickets and on-site orders daily as received from the regions and indexing each ticket onto the appropriate EMR after confirmation.

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.

Responsibilities

• Develop and maintain working knowledge of current HME products and services offered by the company.
• Accurately enters patient notes and updates into patient records.
• Reviews documentation to make sure it is valid prior to processing an order to ensure completeness and accuracy.
• Verifies or obtains alternate contact information.
• Verifies delivery address, delivery instructions and telephone number for all orders.
• Understands and utilizes the most cost-effective delivery method for items ordered.
• Documents accounts with any delivery expectations and requests.
• Identifies trends, either system or process driven, that can be changed or modified to improve efficiency and create cost savings.
• Accurately process, verify, and/or submit documentation and orders.
• Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles.
• Navigates through multiple online EMR systems to obtain applicable documentation.
• Enters and reviews all pertinent information in EMR system including authorizations and expiration dates.
• Communicates with leadership on an ongoing basis regarding any noticed trends with insurance companies.
• Verifies insurance carriers are listed in the company's database system, if not requests the new carrier is entered.
• Meets quality assurance requirements and other key performance metrics.
• Maintains and reviews all required documentation for insurance coverage and reimbursement per insurance guidelines and company policy.
• Contacts AdaptHealth sales and/or operations teams, and physicians, to obtain additional supporting medical necessity documents.
• Reports to supervisor any apparent issues and coordinates submission of all required documentation.
• Assists with implementation of performance improvement program as it relates to billing and coding performance.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Merchant Wholesalers, Durable Goods
• Education Level: High school or GED