Senior Advanced Care Specialist (SE Resupply Department) Position Available In Guilford, North Carolina

Senior Advanced Care Specialist (SE Resupply Department)
Senior Advanced Care Specialist (SE Resupply Department)
High Point or Dunn NC or Columbia SC areas, NC

• Southeast Resupply Department
  Job Type
  Full-time
  Description

Essential Functions and Job Responsibilities:

• Prioritize urgent and non-urgent referrals to ensure adherence to timelines.
• Maintain a strong working knowledge of the company’s current products and services.
• Respond promptly to calls and emails, meeting established performance goals.
• Accurately document call information following standard operating procedures.
• Address inquiries about products, services, retail locations, and general service line details based on customer needs.
• Process orders, route calls appropriately, and follow up as needed.
• Review all documentation for accuracy and completeness.
• Process, verify, and submit documentation and orders with precision.
• Perform insurance verifications to confirm patient eligibility, coverage, co-insurance, and deductibles.
• Obtain prior authorizations and process physician orders for insurance carrier approval when required.
• Communicate with physicians and clinicians to discuss payer guidelines and address insurance denials.
• Collaborate on appeals with physicians, clinicians, and sales to resolve adverse insurance determinations and ensure patients receive prescribed items.
• Coordinate discharge planning and setup completion with internal teams, including sales, respiratory therapists, and dietitians.
• Conduct financial discussions with patients and provide alternative solutions as needed.
• Navigate multiple online EMR systems to retrieve relevant documentation.
• Input and review all necessary information in the EMR system, including authorizations and expiration dates.
• Inform Customer Service and Management of trends with insurance companies.
• Verify that insurance carriers are listed in the company’s database and request additions when necessary.
• Contact patients when documentation does not meet payer guidelines, provide updates, and offer solutions to facilitate referrals.
• Communicate follow-up care requirements with patients in alignment with payer guidelines.
• Work through weekly reports to gather documentation required by payers and prevent disruptions in care.
• Meet quality assurance standards and key performance metrics.
• Resolve customer complaints and address issues effectively.
• Exhibit strong attention to detail and organizational skills.
• Actively listen to patients and handle stressful situations with compassion and empathy.
• Demonstrate flexibility in job responsibilities and hours of operation.
• Use company-provided tools, including Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI, PECOS, and instructional documents, to maintain quality standards.
• Maintain patient confidentiality and function within the guidelines of HIPAA.
• Completes assigned compliance training and other educational programs as required.
• Maintains compliance with AdaptHealth’s Compliance Program.
• Assist operations with on-call responsibilities as needed during non-business hours in accordance with
  company policy.
• Depending on the geographic territory and size of the branch location, may require assisting operations
  with deliveries.

Job Title:

Advanced Care Specialist FLSA Classification:

Non-Exempt

Department:

Advanced Care Rev Date:

08/20, 5/22, 1/25

Reports To:

Manager or Supervisor Approved by: Human Resources
Job Description

• Retain knowledge of and consistently adhere to procedures for the use of Personal Protective Equipment
  (PPE), infection control and hazardous materials handling.
• Perform other related duties as assigned
  Requirements

Competency, Skills and Abilities:

• Strong customer service expertise with excellent interpersonal skills.
• Highly organized, detail-oriented, and capable of critical thinking.
• Proficient in analytical and problem-solving skills with keen attention to detail.
• Sound decision-making abilities.
• Excellent verbal and written communication skills.
• Effective at prioritizing and managing multiple tasks efficiently.
• Advanced proficiency in Microsoft Office and general computer skills.
• Familiarity with Medicare, Medicaid, and commercial health plan methodologies and documentation requirements (preferred).
• Flexible and adaptable in rapidly changing environments; patient, proactive, accountable, and a team player.
• Able to interpret and execute instructions in written, verbal, or diagrammatic form.
• Works well independently while adhering to detailed instructions.
• Quick learner with strong technical aptitude; capable of understanding data flow and system interactions.

Education and Experience Requirements:

• High School Diploma or equivalent
• One (1) year work-related experience with ventilators, respiratory assist devices, enteral nutrition, or other advanced care divisions/products.
• 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.

Physical Demands and Work Environment:

• The work environment can be stressful at times due to fluctuating office activities and workload levels.
• Requires the ability to bend, stoop, stretch, stand, and sit for extended periods.
• Involves prolonged sitting and frequent exposure to computer screens.
• Requires repetitive wrist, hand, and finger motions due to extensive computer use.
• Must be capable of occasionally lifting 5 to 10 pounds as needed.
• Demonstrates excellent verbal and written communication skills, with the ability to empathize, show compassion, and maintain courtesy and respect for privacy.
• Maintains mental alertness to effectively perform essential job functions.
• May encounter angry or irate customers or patients.
• Potential exposure to hazardous materials, loud noise, extreme temperatures, and airborne, bloodborne, or other infectious pathogens.