Senior Advanced Care Specialist (SE Resupply Department)

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 ven