Operations Specialist Non-Driving

Description Position Summary: The Operations Specialist is a non-driving position responsible for supporting the Operations Team through multiple tasks required for the successful support of each region's individual needs. The lead specialist serves as a subject matter expert, conducts new hire training and mentor to the team. Essential Functions and Job Responsibilities: * Supports operations team with discovery and training as necessary with AdaptHealth processes. * Responsible for providing support during process improvement initiatives to assist with driving all areas of workflow, including verification, and data analysis. * Develop and maintain working knowledge of current products and services offered by the company * Must be familiar with payer guidelines and reading clinical documentation to determine qualification status and compliance for all equipment and services. * Working knowledge in all areas of AdaptHealth customer service, intake, daily operations and revenue cycle processes and workflows from beginning to end, which may include * Review all required documentation to ensure accuracy * Accurately process, verify, and/or submit documentation * Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles * Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required (if helping a region) * Navigate through multiple online EMR systems to obtain applicable documentation * Enter and review all pertinent information in EMR system including authorizations and expiration dates * Meet quality assurance requirements and other key performance metrics * Pays attention to detail and has great organizational skills * Actively listens to teams, region leaders and handle stressful situations with compassion and empathy. * Ability to analyze data and reports to identify execution errors in workflow, troubleshoot and fix the exceptions, advise staff on corrections. * Collaborate with the Operations Team on exceptions and solutions within workflow processes * Communicate with operations teams and leadership on an on-going basis regarding any noticed trends in process errors with insurance companies * Assist with various projects and tasks as needed for various unique processes * Participate in the effort to define, document, and refine processes, procedures and workflows for business operations based on industry and company best-practices. * Participate in the effort to create training materials and train client engagement and service teams * Must be able to navigate through multiple online EMR systems to obtain applicable documentation. * Works with insurance verification team to ensure all needs are met for both teams to provide accurate information to the patient and ensure payments. * Assume on-call responsibilities during non-business hours in accordance with company policy. * Lead Responsibilities: * Supervise and provide guidance to team members in daily operations and complex case resolution * Lead team meetings and facilitate training sessions for staff development * Monitor team performance metrics and productivity standards, providing feedback and coaching as needed * Serve as primary escalation point for difficult customer issues and complex regulatory compliance questions * Develop and implement process improvements and workflow optimization strategies * Coordinate with management on staffing needs, scheduling, and resource allocation * Conduct new employee onboarding and ongoing training programs * Maintain advanced expertise in Medicare guidelines, payer policies, and regulatory changes to guide team decisions * Prepare reports and analysis on team performance, trends, and operational metrics for management review * Maintains patient confidentiality and functions within the guidelines of HIPAA. * Completes assigned compliance training and other education programs as required. * Maintains compliance with AdaptHealth's Compliance Program. * Performs other related duties as assigned. Competency, Skills and Abilities: * Excellent ability to communicate both verbally and in writing * Ability to prioritize and manage multiple tasks * Proficient computer skills and knowledge of Microsoft Office * Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction * General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred. * Work well independently and as part of a group * Ability to adapt and be flexible in a rapidly changing environment, be patient, accountable, proactive, take initiative and work effectively on a team Requirements Education and Experience Requirements: * High school diploma or equivalent required; Associate's degree in healthcare administration, Business Administration, or related field preferred * Related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry. * Exact job experience is health care organization, pharmacy that routinely bills insurance or provides Diabetics, Medical Supplies, HME, Pharmacy or healthcare (Medicare certified) services * Specialist Level: (Entry Level): One (1) year of work-related experience * Senior Level: One (1) year of work-related experience plus Two (2) years exact job experience * Lead Level: One (1) year of work-related experience plus Four (4) years exact job experience Physical Demands and Work Environment: * Work environment will be stressful at times, as overall office activities and work levels fluctuate * Must be able to bend, stoop, stretch, stand, and sit for extended periods of time * Subject to long periods of sitting and exposure to computer screen * Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use * Ability to effectively communicate both verbally and written with internal and external customers with the ability to demonstrate empathy, compassion, courtesy, and respect for privacy. * Mental alertness to perform the essential functions of position.

Created: 2026-04-13