Lead, Quality Assurance Specialist

4 days ago

Elmhurst, Illinois, United States AdaptHealth LLC Full time

AdaptHealth Opportunity

At AdaptHealth, we offer comprehensive 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, we would love to hear from you.

Job Summary

The Lead Quality Assurance Specialist is 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. Also 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.

Key Responsibilities

  • Mentors, guides and provides oversight assistance of the team.
  • Identifies areas where technical solutions would improve business performance.
  • Demonstrates various techniques and documentation to streamline production processes.
  • Identifies team member strengths and opportunities and reports findings up to supervisors.
  • Assumes responsibility for resolving team member escalations by working with multiple business partners while consistent communication is present with the member.
  • Coaches others on how to navigate through systems to find information needed for patients and calls.
  • As a Subject Matter Expert, assists with training new employees and assists others with problems they encountered while interacting with members over the phone; addresses escalated customer questions and concerns.
  • Accurately processes, verifies, and/or submits documentation and orders.
  • Completes insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles.
  • Must be able to navigate through multiple online EMR systems to obtain applicable documentation.
  • Enters and reviews all pertinent information in EMR system including authorizations and expiration dates.
  • 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.
  • Assists with implementation of performance improvement program as it relates to billing and coding performance.
  • Performs other related duties as assigned.

Requirements

AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual's race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law. This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination.

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