Customer Service Specialist

Paylocity; Knoxville (TN); On-site; USD 36,000 - 52,000; Full time

Job summary

AdaptHealth is seeking a dependable Customer Service Specialist to support patients with insurance verification, order processing, and scheduling of equipment. You will handle inbound and outbound calls, document interactions, and ensure data accuracy across EMR systems.

The role requires strong communication, attention to detail, and compassion in fast-paced environments. A health-care admin background and MS Office proficiency are advantageous.

Qualifications

• High School Diploma or equivalent.
• Minimum one year in health care admin, financial, insurance customer service, claims, billing, call center or management.
• Senior level requires two years of relevant experience; Medicare-related tasks preferred.

Responsibilities

• Learn and understand the full front-end process to support patients.
• Answer inbound calls and outbound calls in a timely manner.
• Document call information per SOP and verify information accuracy.
• Explain products, services, and insurance details to patients as needed.
• Process orders, route calls, and follow up where necessary.
• Verify insurance eligibility, coverage, co-insurance, and deductibles.
• Obtain pre-authorization when required and submit physician orders.
• Navigate multiple EMR systems to obtain documentation and data.
• Enter and review all pertinent information in EMR, including authorizations.
• Communicate trends with insurance companies to leadership.
• Meet quality metrics and resolve patient concerns with empathy.

Skills

Excellent customer service

Analytical and problem-solving

Written and verbal communication

Multitasking and prioritization

Proficient computer skills

Empathy under pressure

Teamwork

Education

High School Diploma or equivalent

Tools

EMR systems

Microsoft Office

Job description

At AdaptHealth we offer full-service 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.

Customer Service Specialist

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 works in a fast-paced environment answering inbound calls and making outbound calls. Maybe responsible for obtaining, analyze, and verify the accuracy of information received from referrals, create orders, and or schedule the patient to receive equipment as ordered by their doctor. Customer Service Specialists should educate Patients of their financial responsibility when applicable.

Job Duties:

• Develop and maintain working knowledge of current products and services offered by the company
• Answer all calls and emails in a timely manner, in adherence to their goals
• Document all call information according to standard operating procedures
• Answer questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs
• Process orders, route calls to appropriate resource, and follow up on customer calls where necessary
• Review all required documentation to ensure accuracy
• Accurately process, verify, and/or submit documentation and orders
• 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
• 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 Customer Service and Management 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
• Responsible for contacting patient when documentation received does not meet payer guidelines to provide updates and offer additional options to facilitate the referral process.
• Meet quality assurance requirements and other key performance metrics
• Facilitate resolution on customer complaints and problem solving
• Pays attention to detail and has great organizational skills
• Actively listens to patients and handle stressful situations with compassion and empathy
• Flexible with the actual work and the hours of operation
• Utilize 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

Competency, Skills and Abilities:

• Excellent customer service skills
• Analytical and problem-solving skills with attention to detail
• Decision Making
• 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

Minimum Job Qualifications:

• 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.

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.