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Quality Assurance Specialist
AdaptHealth. Review delivery/shipping tickets and on-site orders for compliance with accreditation and payer regulations before billing confirmation .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in insurance verification, documentation processing, and compliance with payer regulations within a healthcare environment. Proficient in navigating EMR systems and maintaining knowledge of HME products and services to ensure accurate billing and reimbursement.
Highest-signal resume keywords
Insurance VerificationEMR Systems NavigationHME Products KnowledgeCMS Billing GuidelinesDocumentation Accuracy
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Documentation ProcessingBilling ComplianceClaims ManagementQuality AssuranceCost-Effective Delivery Methods
Soft Skills
CommunicationProblem-SolvingAttention to Detail
Certifications & Qualifications
High School Diploma
Industry Keywords
Healthcare AdministrationPayer RegulationsMedicare Certified HMEHome Medical SuppliesInsurance Customer Services
About the role
Key responsibilities & impact- Review delivery/shipping tickets and on-site orders for compliance with accreditation and payer regulations before billing confirmation
- Confirm delivery/shipping tickets and on-site orders daily
- Index confirmed tickets onto the appropriate EMR
- Develop and maintain knowledge of current HME products and services
- Enter patient notes and updates into patient records
- Review documentation for validity, completeness, and accuracy
- Verify or obtain alternate contact information, delivery addresses, instructions, and telephone numbers
- Select cost-effective delivery methods and document delivery expectations and requests
- Identify system or process trends to improve efficiency and create cost savings
- Process, verify, and submit documentation and orders
- Complete insurance verification
- Enter and review EMR information, authorizations, and expiration dates
- Communicate insurance trends to leadership
- Verify insurance carriers in the company database and request additions when needed
- Maintain and review documentation for insurance coverage and reimbursement
- Contact sales, operations teams, and physicians for supporting medical necessity documents
- Report issues to the supervisor and coordinate required documentation submission
- Assist with performance improvement related to billing and coding
- Perform other duties as assigned
Requirements
What you’ll need- 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 includes the listed tasks in a Medicare certified HME, Diabetic, Pharmacy, or home medical supplies environment that routinely bills insurance
- Ability to navigate through multiple online EMR systems
- Knowledge of HME products and services
- Knowledge of CMS or managed care payer billing guidelines
- Ability to complete insurance verification and determine eligibility, coverage, co-insurances, and deductibles
- Ability to accurately process, verify, and submit documentation and orders
- Ability to meet quality assurance requirements and key performance metrics