Customer Service Representative

The Customer Service Representative is a non-driving position responsible for supporting the Operations Team through multiple tasks required for the successful support of each region’s individual needs.

Essential Functions and Job Responsibilities:

• Supports operations team with discovery and training as necessary with AdaptHealth processes.
• Responsible for providing support during process improvement initiatives to assist with driving all areas of workflow, including verification, and data analysis.
• Develop and maintain working knowledge of current products and services offered by the company
• Must be familiar with payer guidelines and reading clinical documentation to determine qualification status and compliance for all equipment and services.
• Working knowledge in all areas of AdaptHealth customer service, intake, daily operations and revenue cycle processes and workflows from beginning to end, which may include
• Review all required documentation to ensure accuracy
• Accurately process, verify, and/or submit documentation
• 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 (if helping a region)
• Navigate through multiple online EMR systems to obtain applicable documentation
• Enter and review all pertinent information in EMR system including authorizations and expiration dates
• Meet quality assurance requirements and other key performance metrics
• Pays attention to detail and has great organizational skills
• Actively listens to teams, region leaders and handle stressful situations with compassion and empathy.
• Ability to analyze data and reports to identify execution errors in workflow, troubleshoot and fix the exceptions, advise staff on corrections.
• Collaborate with the Operations Team on exceptions and solutions within workflow processes
• Communicate with operations teams and leadership on an on-going basis regarding any noticed trends in process errors with insurance companies
• Assist with various projects and tasks as needed for various unique processes
• Participate in the effort to define, document, and refine processes, procedures and workflows for business operations based on industry and company best-practices.
• Participate in the effort to create training materials and train client engagement and service teams
• Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
• Works with insurance verification team to ensure all needs are met for both teams to provide accurate information to the patient and ensure payments.
• Assume on-call responsibilities during non-business hours in accordance with company policy.
• Lead Responsibilities:
• Supervise and provide guidance to team members in daily operations and complex case resolution
• Lead team meetings and facilitate training sessions for staff development
• Monitor team performance metrics and productivity standards, providing feedback and coaching as needed
• Serve as primary escalation point for difficult customer issues and complex regulatory compliance questions
• Develop and implement process improvements and workflow optimization strategies
• Coordinate with management on staffing needs, scheduling, and resource allocation
• Conduct new employee onboarding and ongoing training programs
• Maintain advanced expertise in Medicare guidelines, payer policies, and regulatory changes to guide team decisions
• Prepare reports and analysis on team performance, trends, and operational metrics for management review
• Maintains patient confidentiality and functions within the guidelines of HIPAA.
• Completes assigned compliance training and other education programs as required.
• Maintains compliance with AdaptHealth's Compliance Program.
• Performs other related duties as assigned.

Competency, Skills and Abilities:

• 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

Requirements

Education and Experience Requirements:

• High school diploma or equivalent required; Associate’s degree in healthcare administration, Business Administration, or related field preferred
• Related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
• Exact job experience is health care organization, pharmacy that routinely bills insurance or provides Diabetics, Medical Supplies, HME, Pharmacy or healthcare (Medicare certified) services
• Specialist Level: (Entry Level):

One (1) year of work-related experience

• Senior Level:

One (1) year of work-related experience plus

Two (2) years exact job experience

• Lead Level:

One (1) year of work-related experience plus

Four (4) years exact job experience

Physical Demands and Work Environment:

• Work environment will be stressful at times, as overall office activities and work levels fluctuate
• Must be able to bend, stoop, stretch, stand, and sit for extended periods of time
• Subject to long periods of sitting and exposure to computer screen
• Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use
• Ability to effectively communicate both verbally and written with internal and external customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy.
• Mental alertness to perform the essential functions of position.

Job Type: Full-time

Pay: $23.00 - $28.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• On-the-job training
• Paid time off
• Professional development assistance
• Referral program
• Vision insurance

Shift:

• Day shift

Work Location: In person