Quality Assurance Specialist

About AdaptHealth

AdaptHealth is a leading provider of full-service home medical equipment products and services, dedicated to empowering patients to live their best lives outside of the hospital and within the comfort of their homes. We are actively recruiting individuals who are passionate about making a profound impact on the quality of patients’ lives.

Quality Assurance Specialist at AdaptHealth

The Quality Assurance Specialist plays a critical role in ensuring AdaptHealth adheres to stringent compliance standards set by accreditation bodies and payer regulations/guidelines. This involves meticulously reviewing delivery/shipping tickets and on-site orders before confirming them in the billing system. Your review will encompass essential elements such as proof of delivery standards and the accuracy of CMS or managed care payer billing guidelines. A key daily responsibility will be confirming all delivery/shipping tickets and on-site orders as received from various regions and indexing each ticket onto the appropriate EMR after confirmation.

Key Responsibilities

• Develop and maintain a comprehensive working knowledge of current HME products and services.
• Accurately enter and update patient notes and records.
• Review documentation rigorously to ensure validity, completeness, and accuracy prior to processing orders.
• Verify or obtain alternate contact information.
• Confirm delivery addresses, specific delivery instructions, and telephone numbers for all orders.
• Understand and utilize the most cost-effective delivery methods for ordered items.
• Document accounts thoroughly with any specific delivery expectations and requests.
• Proactively identify system or process trends through daily activities that can be modified to enhance efficiency and achieve cost savings.
• Accurately process, verify, and/or submit documentation and orders.
• Complete insurance verification to determine patient eligibility, coverage, co-insurances, and deductibles.
• Navigate multiple online EMR systems efficiently to gather applicable documentation.
• Enter and review all pertinent information in the EMR system, including authorizations and expiration dates.
• Communicate regularly with leadership regarding any observed trends with insurance companies.
• Verify insurance carriers are properly listed in the company’s database; request new carrier entry if not.
• Meet all quality assurance requirements and other established key performance metrics.
• Maintain and review all required documentation for insurance coverage and reimbursement, adhering to insurance guidelines and company policy.
• Contact AdaptHealth sales, operations teams, and physicians to obtain additional supporting medical necessity documents.
• Report any apparent issues to your supervisor and coordinate the submission of all required documentation.
• Assist with the implementation of performance improvement programs related to billing and coding performance.
• Perform other duties as assigned.

Minimum Qualifications

• High School Diploma or equivalent.
• One (1) year of work-related experience in healthcare 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 includes tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.

Key Skills/Competency

• Quality Assurance
• Compliance Standards
• Billing Systems
• EMR Systems
• Insurance Verification
• Documentation Review
• Healthcare Regulations
• Data Entry Accuracy
• Process Improvement
• Medical Equipment