Senior Quality Assurance Specialist

5 days ago

🔔 Pennsylvania – Remote

Although this job is listed in Pennsylvania, this company may be open to hiring remote in other states.

⏰ Full Time

🟠 Senior

🔧 QA Engineer (Quality Assurance)

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AdaptHealth

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AdaptHealth is a company that provides healthcare solutions with a focus on respiratory health, sleep health, diabetes health, and wellness at home. With a network of 671 locations in 47 states, AdaptHealth delivers 38,225 home medical supplies each day and holds 2,825 insurance contracts. The company is dedicated to empowering patients to live their best lives, offering products and services such as CPAP machines, oxygen supplies, diabetes supplies, and a variety of medical equipment. AdaptHealth is highly rated by its customers for fast, reliable, and courteous service. They emphasize patient care solutions that integrate seamlessly into daily life, supported by online support and fast shipping services. Their mission is to change lives by providing the necessary healthcare tools to patients nationwide.

10,000+ employees

Founded 2019

⚕️ Healthcare Insurance

🧘 Wellness

📋 Description

• 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. • 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. • Through daily work activities 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. • Must be able to navigate through multiple online EMR systems to obtain applicable documentation. • Enter and review all pertinent information in EMR system including authorizations and expiration dates. • Communicate with leadership on an on-going basis regarding any noticed trends with insurance companies. • Verify insurance carriers are listed in the company’s database system, if not request the new carrier is entered. • Meet quality assurance requirements and other key performance metrics. • Maintain and review all required documentation for insurance coverage and reimbursement per insurance guidelines and company policy. • Contact AdaptHealth sales and/or operations teams, and physicians, to obtain additional supporting medical necessity documents. • Report to supervisor any apparent issues and coordinate submission of all required documentation. • Assist with implementation of performance improvement program as it relates to billing and coding performance. • Other duties as assigned.

🎯 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.