Specialist, Billing
Specialist, Billing
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Job Description
Welcome to Ovation Healthcare!
At Ovation Healthcare (formerly QHR Health) weve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence we help rural healthcare providers fulfill their missions.
The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcares vision is to be a dynamic integrated professional services company delivering innovative and executable solutions through experience and thought leadership while valuing trust respect and customer focused behavior.
Were looking for talented motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives in a collegial atmosphere of professionalism and teamwork.
Ovation Healthcares corporateheadquartersis located in Brentwood TN. For more information visit.
Summary:
The Specialist Billing is responsible for managing the daily billing and ensuring timely accurate cleanclaims claim reviews and resolves billing daily claim edits and ensuring compliance with Insurancebilling policies and regulations.
Duties and Responsibilities:
Extensive understanding of billing guidelines for UB/1500 claims and a deep understanding ofeach claim field requirement.
Maintain a list of split billing requirements by payer and add to the team crosswalk and keepabreast of any payer changes. The billing specialist should be well versed in Payer portal appealuploads and assist with providing the internal team feedback when necessary.
Import claims from host system into claims processing system when required. Review claims thatare pended for edits and resolve.
Prepare and submit accurate claims for patient services ensuring compliance with third partypayer guidelines and regulations.
Review patient accounts and reconcile payments with secondary payers and review remittanceadvice ensuring all payments are posted correctly and outstanding balances are addressedbefore filing the secondary payer.
Ensure all billing and collection practices are compliant with CMS regulations HIPAA andcompany policies. Maintain accurate records of all claims and ensure proper documentation inthe patient account system.
Meet daily productivity and quality standards as assigned.
Work with internal departments such as patient financial services finance and billing to addressany issues or disputes affecting patient accounts.
Assist management in maintaining or reducing account receivable (AR) days to meet industrystandards and improve organizational cash flows.
Knowledge Skills and Abilities:
Proven experience in third party insurance billing collections or patient accounts preferably in ahealthcare setting.
In-depth knowledge of billing codes guidelines and regulations. Familiarity with electronic healthrecord (EHR) systems billing software and remittance advice processing. Strong communicationskills with the ability to explain Medicare billing details and resolve patient concerns effectively.
Ability to handle sensitive information and maintain confidentiality in accordance with HIPAAregulations.
Detail-oriented with strong organizational skills and the ability to manage multiple accountssimultaneously.
Problem-solving abilities particularly regarding billing discrepancies and denied claims.
Work Experience Education and Certificates:
Experience utilizing Payer portals client systems and clearing house requirements
3-5 years of experience as a primary biller in hospital Business Office. Medical Terminology ICD-10CPT and DRG knowledge a preferred knowledge of third-party Insurance payer guidelines
High school diploma or equivalent; additional training in medical billing is a plus.
Working Conditions and Physical Requirements:
Work from home and remote location with a stable internet connection a quiet and dedicatedworkspace free of distractions and access to necessary office equipment.
The ability to have dailycommunication with team members management and clients through email phone calls videomeetings and other collaborative tools.
Primarily requires sitting at a desk for extended period. Properlighting and ergonomics shole be maintained to reduce eye strain.
Travel Requirements:
None
Required Experience:
Unclear Seniority
Employment Type
Full-Time
