Customer Service Specialist Job at Adapthealth in Riverside

AdaptHealth is a premier full-service home medical equipment company in the United States – offering a full-scope of cost-efficient HME and respiratory care products and services that aim to keep patients comfortable and thriving in their own homes. We are dedicated to pursuing better and use technology, process and the power of our national network to do so. We have a relentless commitment to using innovation to transform the durable medical equipment industry, break the status quo and provide the best quality care.

Position Summary:

Customer Service Specialists are responsible for learning and understanding the entire front-end process to ensure successful service for our patients. The Customer Service Specialists work in a fast-paced environment answering inbound calls and making outbound calls. May be responsible for obtaining, analyzing, and verifying the accuracy of information received from referrals, creating orders, and scheduling the patient to receive equipment as ordered by their doctor. Customer Service Specialists should educate patients of their financial responsibility when applicable.

Essential Functions and Job Responsibilities:

• Develops and maintains working knowledge of current products and services offered by the company.
• Answers all calls and emails in a timely manner, in adherence to their goals.
• Documents all call information according to standard operating procedures.
• Answers questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs.
• Processes orders, routes calls to appropriate resources, and follows up on customer calls where necessary.
• Reviews all required documentation to ensure accuracy.
• Accurately processes, verifies, and/or submits documentation and orders.
• Completes insurance verification to determine patient’s eligibility, coverage, co-insurances, and deductibles.
• Obtains pre-authorization if required by an insurance carrier and processes physician orders to insurance carriers for approval and authorization when required.
• 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 Customer Service and Management 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 to be entered.
• Contacts patient when documentation received does not meet payer guidelines to provide updates and offers additional options to facilitate the referral process.
• Meets quality assurance requirements and other key performance metrics.
• Facilitates resolution on customer complaints and problem solving.
• Pays attention to detail and has great organizational skills.
• Actively listens to patients and handles stressful situations with compassion and empathy.
• Remains flexible with the actual work and the hours of operation.
• Utilizes 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.
• Maintains patient confidentiality and functions within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliance with AdaptHealth’s Compliance Program.
• Assists operations with on-call responsibilities as needed during non-business hours in accordance with company policy.
• May assist Operations with deliveries.
• Retains knowledge of and consistently adheres to procedures for the use of Personal Protective Equipment (PPE), infection control and hazardous materials handling.
• Performs other related duties as assigned.

Competency, Skills and Abilities:

• Analytical and problem-solving skills with attention to detail.
• Decision making skills.
• 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 the flow of data through systems as well as system interaction.
• General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
• Works well independently and as part of a group.
• Ability to adapt and be flexible in a rapidly changing environment, remains patient, accountable, proactive, takes initiative and works effectively on a team.

Education and Experience 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 environment.

Physical Demands and Work Environment:

• Work environment may 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.
• Must be able to lift 30 pounds as needed.
• May be exposed to upset customers or patients.
• May be exposed to hazardous materials, loud noise, extreme heat/cold, direct or indirect contact with airborne, bloodborne, and/or other potentially infectious pathogens.
• This position is primarily performed within an office building.

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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