PAP Compliance & Claims Specialist

Uhalumni; Kahului (HI); On-site; Full time

Job description

Responsible for ensuring customers receive PAP equipment by scheduling an appointment for the customer to come in to pick up equipment and receive proper instruction on how to best use the equipment. Explains customers financial responsibility and ensure payment.

PAP Specialists are responsible for preparing and submitting audit paperwork for Medicare and other insurance claims to ensure continued compliance with healthcare guidelines. The PAP Specialist will accurately respond to claim audits and communicate audit results in such a way to provide education and appropriate process changes that directly impact the daily functions of AdaptHealth.

Responsible for monitoring, communicating, and managing all clients on Positive Airway Pressure devices. Responsible for encouraging client compliance with PAP equipment and program.

Job Duties

• Develop and maintain working knowledge of current HME products and services offered by the company and all applicable insurance guidelines respecting eligibility for coverage and reimbursement.
• Is actively involved in team activities, evidenced by participation, mentoring, and training with co-workers
• Assists in the development and maintenance of reference materials for use by staff and facilitates the sharing of information
• Develops relationships with branches, other teams to accomplish goals
• Participates in monthly team meetings and trainings
• Responsible for entering data in an accurate manner into database including although not limited to payer, authorization requirements, coverage limitations and status of any requalification
• Collaborates with physician offices, AdaptHealth sales and support staff to ensure timely receipt of documentation as well as educating, as necessary.
• Identify trends and providing feedback and education to internal and external customers on compliant documentation requirements for services provided.
• Maintain patient confidentiality and function within the guidelines of HIPAA
• Completes assigned compliance training and other educational programs as required
• Maintains compliant with AdaptHealth’s Compliance Program
• Other duties as assigned.

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 HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance.