Quality Assurance Specialist

AdaptHealth LLC; United States; Hybrid; USD 55,000 - 75,000; Full time

Job summary

AdaptHealth LLC is hiring a Quality Assurance Specialist to review delivery tickets and on-site orders against accreditation and payer guidelines before billing.

The role includes confirming tickets, indexing in EMR, insurance verification, and ensuring documentation accuracy across regions. Strong knowledge of CMS guidelines and payer billing is essential, with emphasis on quality and cost-effective processes.

Qualifications

• Experience in health care administrative, financial, or insurance customer services, claims or billing.
• Ability to verify insurance, manage documentation, and support billing accuracy.

Responsibilities

• Review delivery/shipping tickets and on-site orders for compliance with accreditation and payer guidelines.
• Confirm all tickets and orders daily and index into EMR after verification.
• Verify insurance eligibility, coverage, and patient details for billing.
• Navigate multiple EMR systems to obtain required documentation.
• Communicate trends and issues with leadership and coordinate documentation submissions.
• Assist with performance improvement related to billing and coding.

Skills

Healthcare administration

Billing and claims

Insurance verification

EMR navigation

Education

High School diploma or equivalent

Tools

EMR systems

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. If you are passionate about making a profound impact on the quality of patients' lives, we would love to hear from you.

Quality Assurance Specialist

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.

Job Duties:

• 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

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.

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.